Using routinely-collected, linked data to measure and monitor health system performance in Australia: development of an indicator of continuity of primary health care

ObjectiveTo examine a potential new Australian health system indicator--continuity of care (CoC) in general practice--derived from whole-of-population linked administrative data. MethodsUsing data from Census 2016 and 2021 and the Medicare Benefits Schedule, available via the Person-Level Integrated Data Asset (PLIDA), we examined an indicator of CoC in general practice, the Usual Provider Index (UPI), over eight overlapping 2-year periods (2016-17 to 2022-23), and the 2-year period following the introduction of universal telehealth in April 2020). We measured population coverage of the UPI, sociodemographic- and health-related variation in high COC (UPI[≥]0.7), and changes in CoC over time. ResultsPopulation coverage of the UPI was high (>75%); higher for groups with greater healthcare needs, including older people and people with chronic conditions. Coverage decreased with increasing remoteness. In 2022-23, 36% of those with a UPI score had high CoC; proportions with high CoC were greater for older people, those born overseas, not proficient in English, and with health conditions, but lower for people living in more remote areas. Prior to 2020, 32-33% of the population had high CoC, increasing to 39% in the 2-year period directly following the introduction of universal telehealth. ConclusionWhen derived from whole-of population linked administrative data, the UPI is a suitable indicator of CoC for people with varying healthcare needs, and across different settings. Using new national data assets, the UPI could be included in routine health system reporting as one indicator of quality of care. Online Short SummaryO_ST_ABSWhat is known?C_ST_ABSHealth system performance monitoring aims to facilitate health system planning and improvement. Whole-of-population linked administrative data may be used to extend current health system indicators in Australia. What this paper adds?We examined a potential new indicator--continuity of care within general practice--by assessing coverage and sensitivity to differences between groups and over time. Coverage was high, those with greater healthcare need had higher continuity, and continuity increased after the introduction of telehealth. What are the implications?New national data assets can be used to derive health system indicators, enhancing insight into Australian healthcare.