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Using the 10 PIPQI Measures for Quality Improvement

The Practice Incentives Program (PIP) Quality Improvement (QI) Incentive is a payment to general practices that participate in QI activities in partnership with their local PHN. To be eligible, practices also commit to submitting nationally consistent, de-identified data, against 10 Key Improvement Measures that contribute to local, regional and national health outcomes. This financial incentive aims to encourage practices to work towards delivering optimal care and ultimately, improve health outcomes.

Click through to see the current reported data for each of the 10 PIPQI Quality Improvement Measures (QIMs):

QIM #1: HbA1c recorded (Type 1 diabetes)

As of July 2024, the CCQ region reported 59.4% of regular clients of all ages who had a recorded diagnosis of Type 2 diabetes had an HbA1c result recorded within the previous 12 months in their GP record, higher than the 57.3% across Queensland and 56.9% nationally.

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #1: HbA1c recorded (Type 2 diabetes)

As of July 2024, the CCQ region reported 72.7% of regular clients of all ages who had a recorded diagnosis of Type 2 diabetes had an HbA1c result recorded within the previous 12 months in their GP record, higher than the 71.5% across Queensland and 71.8% nationally.

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #1: HbA1c recorded (undefined diabetes)

As of July 2024, the CCQ region reported 68.6% of regular clients of all ages who had a recorded diagnosis of Type 2 diabetes had an HbA1c result recorded within the previous 12 months in their GP record, higher than the 64.3% across Queensland and 65.4% nationally.

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #2: Smoking status recorded

As of July 2024, the CCQ region reported 79.7% of regular clients aged 15 years and over had their smoking status recorded in their GP record (where recorded means in the previous 12 months for those aged 15–29 and since the age of 30 for those aged 30 years and over), higher than the 73.3% across Queensland and 68.7% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #3: Height/weight recorded

As of July 2024, the CCQ region reported 29.4% of regular clients aged 15 years and over had their height and weight measurements recorded in their GP record within the previous 12 months in the CCQ region, lower than the 30.8% across Queensland but higher than the 24.4% nationally.

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #4: Influenza vax recorded (aged 65+)

As of July 2024, the CCQ region reported 55.1% of regular clients aged 65 years and over had an influenza immunisation status recorded in their GP record in the previous 15 months, lower than the 56.7% across Queensland and 55.9% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #5: Influenza vax recorded (diabetes)

As of July 2024, the CCQ region reported 50.6% of regular clients with diabetes had an influenza immunisation status recorded in their GP record within the previous 15 months, higher than the 49.7% across Queensland and 48.4% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #6: Influenza vax recorded (COPD)

As of July 2024, the CCQ region reported 57.7% of regular clients aged 15 years and over with a COPD diagnosis had an influenza immunisation status recorded in their GP record within the previous 15 months in the CCQ region, lower than the 58.2% across Queensland 58.4% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #7: Alcohol consumption recorded

As of July 2024, the CCQ region reported 79.6% of regular clients aged 15 years and over had their alcohol consumption status recorded in their GP record, higher than the 77.3% across Queensland and 68.3% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #8: CVD risk factors recorded

As of July 2024, the CCQ region reported 61.1% of regular clients aged 45 to 74 years without a CVD diagnosis had the necessary risk factors recorded in their GP record to enable CVD risk assessment, lower than the 62.3% across Queensland but higher than the 58.8% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #9: Cervical screening recorded

As of July 2024, the CCQ region reported 41.7% of regular female clients aged 25 to 74 years had a cervical screening test recorded in their GP record after 1 December 2017 and within the previous 5 years, higher than the 41% across Queensland and 40% nationally. 

Click image to enlarge.
Source: AIHW (accessed April 2025)

QIM #10: Blood pressure recorded (diabetes)

As of July 2024, the CCQ region reported 60% of regular clients with diabetes had blood pressure recorded in their GP record within the previous 6 months, higher than the 59% across Queensland and 57.8% nationally. 

https://www.aihw.gov.au/reports/primary-health-care/pipqi-measures-2023-24/contents/pipqi-measures/qim-10-diabetes-with-blood-pressure-recorded

The Improvement Measures are not designed to assess individual general practice or general practitioner performance. They do support a regional and national understanding of chronic disease management in areas of high need.

This activity focuses on how to meet the PIP QI requirements and advance progress on the 10 Key Improvement Measures within your practice.

There are 10 different PIPQI Measures. We suggest starting with one that may be informed by your data and/or practice population needs. Once completing QI for one measure, you might want to consider starting another.

Tip: Consider using the PIPQI measures to create an annual plan and break down quarters to focus on one PIPQI measure for your QI project.

To achieve this goal, you can access a range of resources:

  1. Review the Department of Health, Disability and Ageing resources on PIPQI, including the Practice Incentives Program Quality Improvement Incentive – Guidance.
  2. PIPQI Improvement Measures outlines the 10 measures.
  3. RACGP PIPQI Factsheet

Kickstart your quality improvement activity by bringing together a quality improvement team. Together, you’ll identify the key challenges and come up with innovative solutions, ensuring you all share a clear understanding of the improvement objectives and strategies.

  1. Engage with your Primary Health Coordinator from CCQ; they can offer tailored support, resources and guidance to enhance your QI efforts wherever you are in your QI journey. Your Primary Health Coordinator can support your practice to:
    • Bring a QI team together to decide on an improvement idea
    • Plan, start and finish a QI activity
    • Facilitate QI meetings
    • Create practice-wide systems improvement
  1. Gather data and information. Review current practice PIPQI data and processes for QI activities.
  2. Identify and discuss any common barriers and enablers to optimal care. Consider using process maps, flow charts or driver diagrams to generate change ideas and improve processes.

What data might you need? You’ll need data to understand the problem and measure your outcomes. We suggest you start with:

  1. Primary Sense can provide insight, detailed reports and targeted guidance on improving data quality. The following reports are available within Primary Sense:
    • PIP QI Report – 10 Measures: Reports on the 10 PIPQI Measures as a % completion rate.
    • Patients missing PIPQI or Accreditation Measures: Identifies all patients who are missing one or more PIPQI or accreditation measures.
    • Patients booked in with missing PIPQI measures: Identifies patients with an existing appointment in the next two weeks who are missing one or more PIPQI measures recorded.
  2. Clinical Software: Ensure you are optimising the use of your practice software. For example, ensure your team understand the importance of using coded diagnoses, recording information correctly in the software and actioning items appropriately.

Tip: Set yourself up for success by starting with high quality data. Check out the Data Quality Toolkit for activities focused on data cleansing.

To achieve your goal, you can consider several improvement ideas depending on which measure you choose to focus on. Some examples across the 10 PIPQI Measures could include:

  1. Undertake a seasonal awareness campaign to increase influenza immunisation for priority populations. Utilise the Primary Sense prompt ‘Due Influenza Vaccination’ to opportunistically offer influenza immunisation during appointments.
  2. Complete an audit of diabetes patients to ensure they are coded correctly and have had a HbA1c recorded in the last 12 months. The Primary Sense report ‘Diabetes Mellitus’ will be helpful to identify patients.
  3. Utilise the Primary Sense Report ‘Patients booked in with missing PIPQI measures’ to develop a workflow and create a reminder in the patient file to ensure their records are updated, particularly smoking and alcohol status.
  4. Develop a process for the practice nurse to opportunistically see patients prior to their GP appointment to obtain height, weight, waist measurements, BP and smoking and alcohol status.
  5. Complete an audit of patients >30 missing one or more of the following measures: BP, cholesterol and HDL levels. If eligible and appropriate, consider recalling these patients for a Healthy Heart Check MBS item as part of collecting the necessary information
  6. Focus on patients aged 45-74 to assess whether the following cardiovascular disease risk factors are recorded: smoking status, blood pressure and total cholesterol and HDL levels. Tip: Consider using this as a prompt for completing more Healthy Heart Checks.

Remember to self-report your QI project as a CPD activity: QI is a great tool for measuring tangible outcomes and demonstrating improvement in patient care!

Share your results: With your CCQ practice support team and with your patients. Ensure you document your quality improvement activity to meet PIP QI guidelines and for CPD purposes.

Download PDSA Template

Ready to begin this QI activity?

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