Indigenous-specific primary health care: PI07b-Proportion of Indigenous regular clients with a chronic disease who have a Chronic Disease Management Plan prepared, December 2020

Identifying and definitional attributes
Metadata item type:	Indicator
Indicator type:	Indicator
Short name:	PI07b-Proportion of Indigenous regular clients with a chronic disease who have a Chronic Disease Management Plan prepared, December 2020
METEOR identifier:	731846
Registration status:	Indigenous, Standard 14/07/2021
Description:	Proportion of Indigenous regular clients who have a chronic disease and for whom a Chronic Disease Management Plan was prepared within the previous 24 months.
Rationale:	Preventable chronic diseases are responsible for a significant burden of disease for Indigenous Australians and if poorly controlled increase hospitalisations, complications and the cost of health care. Care plans are the foundation for providing appropriate long-term care (NT AHKPIs).
Indicator set:	Indigenous-specific primary health care national key performance indicators December 2020 Indigenous, Standard 14/07/2021

Collection and usage attributes
Computation description:	Proportion of Indigenous regular clients who have a chronic disease (type 2 diabetes) and for whom a Chronic Disease Management Plan was prepared within the previous 24 months. Presented as a percentage. Count is of people, not plans. Consider only the most recent plan. Chronic Disease Management Plan: The Chronic Disease Management (CDM) Medicare items on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions. It includes MBS-rebated Chronic Disease Management Plans (MBS items: 721; 229; 92024; 92068; 92055; or 92099). Organisations taking part in the Health Care Homes Trial: for the duration of the Health Care Homes trial (currently 1 October 2017 to 30 June 2021), clients who are part of the trial will be deemed to have had a Chronic Disease Management Plan prepared if there is evidence of a Chronic Disease Management Plan recorded.
Computation:	(Numerator ÷ Denominator) x 100
Numerator:	Calculation A: Number of Indigenous regular clients who have type 2 diabetes and for whom an in-person MBS-rebated Chronic Disease Management Plan (MBS items: 721, or 229) was prepared within the previous 24 months. Calculation B: Number of Indigenous regular clients who have type 2 diabetes and for whom a Telehealth MBS-rebated Chronic Disease Management Plan (MBS items: 92024, 92068, 92055, or 92099) was prepared within the previous 24 months.
Numerator data elements:	Data Element / Data Set Person—diabetes mellitus status, code NN Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Guide for use Type 2 diabetes only. Data Element / Data Set Person—Indigenous status, code N Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Guide for use Indigenous only. Data Element / Data Set Person—regular client indicator, yes/no code N Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Guide for use Regular clients only. Data Element / Data Set Person—chronic disease management plan type, code N Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020
Denominator:	Calculation A and B: Total number of Indigenous regular clients who have type 2 diabetes.
Denominator data elements:	Data Element / Data Set Person—diabetes mellitus status, code NN Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Guide for use Type 2 diabetes only. Data Element / Data Set Person—Indigenous status, code N Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Guide for use Indigenous only. Data Element / Data Set Person—regular client indicator, yes/no code N Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Guide for use Regular clients only.
Disaggregation:	1. Sex: a) Male b) Female. 2. Age group: a) 0–4 years b) 5–14 years c) 15–24 years d) 25–34 years e) 35–44 years f) 45–54 years g) 55–64 years h) 65 years and over. 3. Type of Chronic Disease Management Plan: a) In-person MBS-rebated Chronic Disease Management Plan b) Telehealth MBS-rebated Chronic Disease Management Plan.
Disaggregation data elements:	Data Element / Data Set Person—age, total years N[NN] Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Data Element / Data Set Person—sex, code X Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020 Data Element / Data Set Person—chronic disease management plan type, code N Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection NMDS / DSS Indigenous-specific primary health care NBEDS December 2020
Comments:	Census date for reporting is 31 December 2020.
Representational attributes
Representation class:	Percentage
Data type:	Real
Unit of measure:	Person
Format:	N[NN].N
Indicator conceptual framework
Framework and dimensions:	Continuous
Data source attributes
Data sources:	Data Source Indigenous-specific primary health care national Key Performance Indicators (nKPI) data collection Frequency 6 monthly Data custodian Australian Institute of Health and Welfare.
Accountability attributes
Further data development / collection required:	Further work is required to reach agreement on national definitions for other chronic diseases including cardiovascular disease, chronic obstructive pulmonary disease and chronic kidney disease.
Source and reference attributes
Submitting organisation:	Australian Institute of Health and Welfare. Australian Government Department of Health.
Origin:	Department of Health 2016. Chronic Disease Management—Provider information. Canberra: DoH. Viewed 12 February 2017, http://www.health.gov.au/internet/main/publishing.nsf/ Content/mbsprimarycare-factsheet-chronicdisease.htm
Relational attributes
Related metadata references:	Supersedes Indigenous primary health care: PI07b-Proportion of regular clients with a chronic disease for whom a GP Management Plan (MBS Item 721) was claimed, June 2020 Health, Retired 13/10/2021 Indigenous, Superseded 14/07/2021 See also Indigenous-specific primary health care: PI07a-Number of Indigenous regular clients with a chronic disease who have a Chronic Disease Management Plan prepared, December 2020 Indigenous, Standard 14/07/2021

Indigenous-specific primary health care: PI07b-Proportion of Indigenous regular clients with a chronic disease who have a Chronic Disease Management Plan prepared, December 2020

Identifying and definitional attributes

Collection and usage attributes

Representational attributes

Indicator conceptual framework

Data source attributes

Accountability attributes

Source and reference attributes

Relational attributes

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