Web update: Use of emergency department and GP services in 2015–16 - Technical Note - Use of emergency department and GP services in 2015–16

Web update: Use of emergency department and GP services in 2015–16

Use of emergency department and GP services in 2015–16

The Web update: Use of emergency department and GP services in 2015–16 provides information on the measures:

  • Number of in-hours emergency department (ED) attendances per 1,000 people, by place of residence
  • Number of after-hours ED attendances per 1,000 people, by place of residence
  • Number of in-hours general practitioner (GP) attendances per person, by place of residence
  • Number of after-hours GP attendances per person, by place of residence.

The web update provides insights into two Performance and Accountability Framework indicators:

  • Primary care-type emergency department attendances
  • GP-type service use.

This technical note summarises the methods used to calculate the ED measures presented in the web update:

  • Number of in-hours ED attendances per 1,000 people, by place of residence
  • Number of after-hours ED attendances per 1,000 people, by place of residence.

Further details of these measures are available in the indicator specification tables.

The web update also includes the GP-related measures:

  • Number of in-hours GP attendances per person, by place of residence
  • Number of after-hours GP attendances per person, by place of residence.

The methods used to calculate the GP-related measures are presented in the technical note accompanying the concurrent release, available here: Web update: Medicare Benefits Schedule GP and specialist attendances and expenditure in 2015–16

About the data source

Data for ED-related measures were sourced from the National Non-admitted Patient Emergency Department Care Database (NNAPEDCD). The NNAPEDCD is primarily based on the Non-admitted Patient Emergency Department Care National Minimum Data Set (NAPEDC NMDS).

For 2015–16, states and territories were able to provide data for the NNAPEDCD using either the NAPEDC NMDS or the NAPEDC Data Set Specification (DSS). Queensland provided data to the NNAPEDCD using the DSS, while all other states and territories provided data to the NNAPEDCD using the NMDS specification. For the measures presented in this web update, the difference in scope does not affect comparability between states and territories.

For further information see Emergency department care 2015–16: Australian hospital statistics.1

Scope

The scope of the NAPEDC NMDS is patients registered for care in EDs in public hospitals where the ED has:

  • a purposely designed and equipped area with designated assessment, treatment and resuscitation areas
  • the ability to provide resuscitation, stabilisation and initial management of all emergencies
  • medical staff available in the hospital 24 hours a day
  • a designated ED nursing staff and nursing unit manager 24 hours per day, 7 days per week.

Patients who were dead on arrival are in scope if an ED clinician certified the death of the patient. Patients who left the ED after being triaged and then advised of alternative treatment options are also in scope.

The scope includes only physical presentations to EDs. Advice provided by telephone or videoconferencing is not in scope, although it is recognised that advice received by telehealth may form part of the care provided to patients physically receiving care in the ED.

There are differing levels of access to EDs and patterns of health care service delivery and use across metropolitan, regional and remote areas. Since the NNAPEDCD includes only presentations to the EDs described above, it is unlikely to be representative of all emergency occasions of service. This predominantly affects regional and remote areas (for example, which may use alternate emergency care arrangements). The interpretation of the ED using the above criteria also differs across states and territories, resulting in different levels of reporting to the NNAPEDCD.

As such, results for some regional and all remote areas have been suppressed. For further information about how the AIHW determined which areas should have their results suppressed, see Suppression.

Data for public hospitals in the Australian Capital Territory for 2015–16 were not available for publication.

Presentation of results

Geography

The web update presents information at the geography of:

  • Primary Health Network (PHN) areas – 31 geographic areas covering Australia, with boundaries defined by the Australian Government Department of Health.2
  • Statistical Areas Level 3 (SA3s) – 333 geographic areas covering Australia, with boundaries defined by the Australian Bureau of Statistics (ABS).3

All results are based on where the person lived, not where they received the health care service.

Measures calculated at PHN area and SA3 were compiled by applying a geographic concordance to the unit record data. The concordance used the Statistical Area Level 2 (SA2) of the residential address.

Where a SA2 boundary overlapped with more than one PHN area, records were attributed to a PHN area based on the percentage of the SA2 population that fell within each PHN area. Figures were rounded at the end of the calculations to avoid truncation error.

Suppression

All information about an area is suppressed (marked ‘NP – not available for publication’) if any of four conditions (explained following the table) are met. Table 1 below shows how many PHN areas and SA3s are included in the web update and how many are suppressed.

Table 1: Number of areas included in the web update and suppressed

Included in web update Suppressed Total
PHN areas 21 10 31
Metropolitan 14 1 15
Regional 7 6 13
Remote (incl. very remote) 3 3
SA3s 239 94 333
Major cities 176 12 188
Inner regional 46 32 78
Outer regional 17 27 44
Remote (incl. very remote) 21 21
Ungrouped 2 2

The conditions for suppression of information about an area are:

  • The numerator was between 1 and 19.
  • The denominator was less than 2,500 (population <2,500).
  • The area was assessed as remote using the ABS remoteness area4 classification. Remote assessment was made on the basis of population but also included areas with at least 95% of their area classified as remote or very remote.
  • The area was estimated to have less than 90% of emergency occasions of service reported to the NNAPEDCD (see Method to estimate emergency occasions of service by area of residence).

The third and fourth suppression rules relate in part to the fact that access to EDs is not always the same for people in regional and remote areas as it is for people in metropolitan areas. There are differing patterns of health care service delivery and use, and the available data are not sufficiently representative of these patterns in some regional and remote areas to be reported.

Method to estimate emergency occasions of service by area of residence

The purpose of the web update is to understand use of ED services by residents of local areas. However, not all hospitals providing emergency occasions of service are identified in the NNAPEDCD. To ensure comparable information between areas, the AIHW excluded results or flagged caution in interpreting the results, if emergency services for an area were missing.

The percentage of emergency occasions of service not captured in the NNAPEDCD was estimated from information provided by state and territory health departments. This information included emergency occasions of service in hospitals omitted from the NNAPEDCD. The place of residence of patients using the emergency services in these hospitals was assumed to be similar to that of patients admitted to these hospitals and was calculated from data in the 2015–16 National Hospital Morbidity Database. For example if 80% of admissions in Hospital A were from Area X, then 80% of ED attendances were allocated to Area X.

The estimation of the proportion of emergency services included in the NNAPEDCD for each geographic area was: The NNAPEDCD number of services/ (the NNAPEDCD number of services plus the number of additional services identified in state and territory information).

Results for a geographic area are marked as ‘interpret with caution’ (#) if the NNAPEDCD includes between 90% and 95% of services. For areas where less than 90% of services are captured the results are suppressed (marked ‘NP – not available for publication’).

Note that the percentage is an estimate only and the distribution of areas of residence for emergency occasions of service may not be the same as for admissions.

1 AIHW (Australian Institute of Health and Welfare) 2016. Emergency department care 2015–16: Australian hospital statistics. Health services series no.72. Cat. no. HSE 182. Canberra: AIHW.

2 Department of Health 2015. Primary Health Networks (PHNs). Canberra: Department of Health. Viewed 26 June 2017, http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-HomeExternal link, opens in a new window.

3 ABS (Australian Bureau of Statistics) 2011. Australian Statistical Geography Standard (ASGS): Volume 1–Main structure and greater capital city statistical areas, ABS cat. no. 1270.0.55.001. Canberra: ABS.

4 ABS 2013. Australian Statistical Geography Standard: Volume 5 – Remoteness Structure, July 2011. ABS cat. no. 1270.0.55.005. Canberra: ABS. Viewed 19 June 2017, http://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.005External link, opens in a new window.