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The adjusted column was designed to avoid counting patients that have visited multiple clinics in a PHN catchment more than once. The number in the 'Adjusted' column is based on a 'virtual' patient to provide complete data without counting patients more than once. Patients who have visited more than one clinic in an organisation's catchment will be counted more than once in the organisation column (PHN or other) as their data is included in each upload from the individual clinics.

Warning

To identify patients that have been uploaded more than once we are using the Statistical Linkage Key (SLK) that is also in use by the Australian Bureau of Statistics (ABS). For a full definition of the key please see here: SLK Definition ABS website

This key is created when the extract is collected at the practice level and is encrypted before uploaded to PAT CAT. The SLK provides a way to identify duplicate (or more instances) of patient records, it importantly does not allow the identification of the patient. The SLK is not reversible and is purely used for the described purpose in PAT CAT. All data uploaded to PAT CAT is managed and used by the PHN or other organisation, PEN CS does not have access to or ownership of the data.

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Warning

With PAT CAT version 3.3 and above we have introduced the following behaviour for a number of different patient statuses:

  • If a duplicate patient is "Deceased" then virtual patient is marked as "Deceased"
  • If any of the duplicate patients is status "Current", "Transient" or "Banned" then virtual patient is marked as "Active"

The Adjusted column is designed to remove duplicate patients i.e. it will count patients who have visited multiple practices in a PHN catchment only once.

Where a patient has records from multiple practices, a virtual patient record is created which combines the records into one (refer [Virtual Patient]). The number in the 'Adjusted' column will count the 'virtual' patient record for these patients rather than the separate records that have been uploaded .

The Adjusted column will give a more accurate count of patients in the PHN catchment in contrast to the PHN (or other Organisation) total column which includes all patients records that have been uploaded from the individual clinics, and hence patients who have visited more than one practice in an organisation's catchment will be counted more than once.

 
Adjusted Column without Practice Filters 
For example if you have a patient who visited 3 clinics who all uploaded their data to PAT CAT and only one of the three clinics has a diagnosis of diabetes on file, PAT CAT will use the patient record with the most recent visit date. PAT CAT will then go through all reported indicators and check if there are results missing from the most recent record. Anything missing from the original record will be completed using data from the other visits of the patient. If there is more than one result available, the most recent one is used.
This creates a single virtual patient with all available and most up to date information from all clinics visited in the current reporting period.

When used for the whole catchment (no Practice filters) this the Adjusted column will normally show a lower number in than the adjusted PHN total column, as all patients are included and duplicates are removed. Based on current observed numbers this can be between 10 and 25% less patients as visiting more than one practice is very common.

Even when looking at all practices the numbers in Occasionally though when using filters, the adjusted column can , under certain circumstances, be higher than the total. Consider this example:

  1. Filter for active patients with Asthma.
  2. A patient has visited multiple practices
  3. One practice The patient has a diagnosis of Asthma recorded , at one practice but not the other doesn't - this means the virtual patient in the adjusted column has a diagnosis of Asthma
  4. The patient is an active patient (3 or more visits to one practice) at one practice but not the other  - this means the virtual patient in the adjusted column is an active patient

Patient

Asthma

Active Status

Practice 1

Yes

No

Practice 2

No

Yes




Virtual Patient

Yes

Yes

  1. Filter for Active patients with Asthma.
  2. The virtual patient meets the criteria for both but neither of the individual patient records do. When you apply the filter for Active Now when you apply a filter for active patients with Asthma there will be none in the total PHN Total column but one patient in the virtual column

This is not always the case and depends on overall patient characteristics and data uploaded, but it is a scenario to consider when using the adjusted column.

  1. Adjusted column

Using this example, we can show how the Adjusted column can appear to have more patients then the Total practice population count. We have found these cases are rare and usually the differences in the counts are very small.

Practice Name

Total Population

Adjusted Population

Practice 1

0

1

Practice 2

0

1

 

Adjusted Column with Practice Filters

When used with practice filters, the Adjusted column will include patients that have had any visit to the practice(s) selected. The data for the virtual patient may include data that has originated from another practice that is not part of the filter. This often has the effect of returning higher numbers in the Adjusted column compared to the PHN total column.

It should be noted that the virtual patient record, which is a combined record from multiple practices, provides a more complete picture of the patient than the data from one practice alone. This can provide very interesting insights when filtering for one practice alone as it enables a view of how much patient data has been recorded elsewhere and is missing from the practice’s own records.

 

In the example below the filters applied are However when you use a filter for one practice (or a group of selected practices) the adjusted column can show higher numbers as in the example below. The filters applied were for one practice and for patients with diabetes only. As you can see from the total . The PHN total column shows there are 819 patients at the clinic but 1061 in the adjusted column.

There are other patients who have visited other practices, when they visited the other practices they were diagnosed as diabetics in the other practice.

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practice that meet this criteria but the Adjusted column shows 1061. This means there are 242 patients who have been diagnosed with diabetes at one or more other practices and the diagnosis is missing in the practice’s own records.

The practice actually has 1,061 patients with diabetes.

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This might be because there are patients that have come to the practice once for something minor

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so the history wasn’t recorded in detail

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and the diabetes diagnosis was never made, or for a number of other reasons.

 

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The adjusted column was not designed for this function but it can provide interesting data as it enables the PAT CAT user to see information about patient groups that has been entered at other clinics than the one(s) filtered for. It does not provide information where the information was entered, but it might still be useful for some research. 

Generally we don't recommend to use the adjusted data for report reporting when filtering by practice(s), but as the above example shows, there can be valuable information gained from this report when filtering for one practice.