Healthy Communities: Potentially preventable hospitalisations in 2013–14 - Technical Supplement - Introduction

Healthy Communities: Potentially preventable hospitalisations in 2013–14

Introduction

Potentially preventable hospitalisations (also called potentially avoidable hospitalisations or ambulatory care sensitive conditions) are those that may have been prevented by timely and effective provision of non-hospital or primary health care, including prevention.

This does not mean that a person with a potentially preventable hospitalisation (PPH) did not need to be hospitalised at the time of admission. Rather, the admission may have been prevented by timely access to adequate primary health care to prevent the condition, or managing the condition appropriately out of hospital.

The report shows there are regional variations across Australia in the rates of these potentially preventable hospitalisations, and highlights which local areas have higher or lower rates. People who live in areas with lower rates are considered to have access to stronger primary health care systems that are able to prevent hospitalisations for conditions that are better managed in the community.

Classification of potentially preventable hospitalisations

In January 2015, a new national standard for potentially preventable hospitalisations was agreed by national health data standards committees (see Metadata Online Registry (METeOR) specification in the Appendix). To maintain national consistency in reporting, the National Health Performance Authority (the Authority) adopted this standard for reporting 2012–13 and 2013–14 data.

The Authority also changed the name of this indicator in its reporting from potentially avoidable hospitalisations to potentially preventable hospitalisations to align with the national standard. The terms ‘avoidable’ and ‘preventable’, in this context, are interchangeable.

People of all ages are included in this report, although some conditions have specific age exclusions.

In the 2015 specification, there are 22 conditions for which hospitalisation is considered to be potentially preventable, categorised as chronic, acute and vaccine-preventable conditions.

Chronic conditions may be preventable through behaviour modification and lifestyle change. They can also be managed in a primary health care setting to prevent the condition worsening and requiring hospitalisation. They are:

  • Angina
  • Asthma
  • Bronchiectasis
  • COPD (chronic obstructive pulmonary disease)
  • Diabetes complications
  • Heart failure
  • Hypertension
  • Iron deficiency anaemia
  • Nutritional deficiencies
  • Rheumatic heart diseases.

Acute conditions may not be preventable. However, hospitalisation should not occur if people receive timely and adequate access to primary health care. They are:

  • Cellulitis
  • Convulsions and epilepsy
  • Dental conditions
  • Ear, nose and throat infections
  • Eclampsia
  • Gangrene
  • Kidney and urinary tract infections
  • Pelvic inflammatory disease
  • Perforated/bleeding ulcer
  • Pneumonia (not vaccine-preventable).

Vaccine-preventable conditions are preventable and therefore, so is the hospitalisation. They are:

  • Pneumonia and influenza (vaccine-preventable)
  • Other vaccine-preventable conditions.

There were two conditions which were removed from the specification used in the 2011–12 report:

  • Dehydration and gastroenteritis
  • Appendicitis with generalised peritonitis.

There were also changes to the coding of a number of other conditions:

  • Asthma now excludes children aged under 4 years, which resulted in a large decrease in potentially preventable hospitalisations for asthma
  • There were changes to exclusions for angina
  • An additional code was added to cellulitis and procedure exclusions were changed
  • There were substantial changes to the coding of influenza and pneumonia by creating a pneumonia (not vaccine-preventable) condition from ‘influenza and pneumonia’ and many codes changed
  • Both pneumonia (not vaccine-preventable), and pneumonia and influenza (vaccine-preventable), exclude babies aged under two months.

Two diagnoses groups were split:

  • Bronchiectasis was separated from COPD and is now reported individually
  • Eclampsia was separated from ‘convulsions and epilepsy’ and is now reported individually.

The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) 7th edition was used to identify diagnoses related to potentially preventable hospitalisations for data in 2012–13, while ICD-10-AM 8th edition was used for 2013–14 data. Specific ICD-10-AM codes used in this release are available in the Appendix. Appropriate concordances were undertaken to ensure comparability of diagnosis and procedure codes over the time periods. Through this process, no change to either diagnosis or procedure codes were required over the time periods.

ICD-10-AM codes are assigned by clinical coders in each hospital, based on the diagnoses recorded in the patient’s medical record. The diagnosis is recorded for each hospital episode and is specific to that admission.

Some potentially preventable hospitalisations are identified using procedure codes in addition to diagnosis codes. A procedure is a clinical intervention represented by a code that:

  • Is surgical in nature and/or
  • Carries a procedural risk and/or
  • Carries an anaesthetic risk and/or
  • Requires specialised training and/or
  • Requires special facilities or equipment only available in an acute care setting.

The procedure codes used in this report were based on the Australian Classification of Health Interventions 7th edition for 2012–13, and 8th edition for 2013–14 data.

Measures presented

Data are presented for 31 Primary Health Networks (PHNs) and ABS Statistical Areas Level 3 (SA3s). There are 333 SA3s, each of which has a population of between 30,000 and 130,000 people (with some exceptions) – for more information see Geography.

Data for 2013–14 are presented in the report and on the MyHealthyCommunities website as an interactive tool and as an Excel download. Data for 2012–13 are only available to download as an Excel file.

The report and website include data on:

  • Age-standardised hospitalisation rate
  • Number of hospitalisations
  • Total bed days
  • Average length of stay (including same day)
  • Average length of stay (excluding same day).

Average length of stay is defined as the number of bed days divided by the number of hospitalisations. Outliers were not removed. This measure is presented both with and without same-day hospitalisations.

Same-day hospitalisations are where the patient is admitted and discharged on the same day and does not stay overnight.

Measures of potentially preventable hospitalisations are available for downloading as Excel files. These are:

  • Number of hospitalisations
  • Crude hospitalisation rate
  • Age-standardised hospitalisation rate
  • PPH for a condition, as a percentage of all PPH hospitalisations
  • PPH bed days for a condition, as a percentage of all PPH bed days
  • Number of same-day hospitalisations
  • Percentage of same-day hospitalisations
  • Average length of stay (including same day)
  • Average length of stay (excluding same day)
  • Hospital in the home days.

Five selected conditions

The report presents data for five selected conditions, three chronic and two acute, these are:

Chronic

  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes complications
  • Heart failure

Acute

  • Cellulitis
  • Kidney and urinary tract infections.

These five conditions were selected because together they contribute to just under half (47%) of all potentially preventable hospitalisations nationally and almost two-thirds (63%) of bed days for potentially preventable hospitalisations.

Data source

Data for 2012–13 and 2013–14 were sourced from the Admitted Patient Care National Minimum Data Set (APC NMDS) for the financial years 2012–13 and 2013–14. The datasets were supplied in March 2014 and March 2015 respectively.

The APC NMDS includes episodes of care for admitted patients in all public and private acute and psychiatric hospitals, free standing day hospital facilities and alcohol and drug treatment centres in Australia. Hospitals operated by the Australian Defence Force, corrections authorities and in Australia’s offshore territories may also be included. Hospitals specialising in dental, ophthalmic aids and other specialised acute medical or surgical care are included.

Episodes of non-admitted patient care provided in outpatient clinics or emergency departments are excluded from the APC NMDS.

Also excluded, are admitted patient episodes for the following care types:

  • Newborn care (care type=7.0)
  • Organ procurement posthumous (care type=9.0)
  • Hospital boarders (care type=10.0).

Data are collected at each hospital from patient administrative and clinical record systems. Hospitals then forward data to the relevant state or territory health authority on a regular basis. State and territory health authorities provide the data to the Australian Institute of Health and Welfare (AIHW) for national collation on an annual basis.

The counting unit for the APC NMDS is a ‘separation’. Separation is the term used to refer to an episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation). As a record is included for each separation, not for each patient, patients hospitalised more than once in the financial year will have more than one record.

In this release, the word ‘hospitalisation’ is used to mean ‘separation’.

For more information on the 2013–14 APC NMDS, see the Data Set Specification on the AIHW’s Metadata Online Registry (METeOR), http://meteor.aihw.gov.au/content/index.phtml/itemId/491555External link, opens in a new window..