NSW Combined Admitted Patient Epidemiology Data and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Potentially Preventable Hospitalisations (PPH) are based on National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations.Conditions are mutually exclusive. Rotaviral Enteritis is included for records after 1 July 2007 onwards.
Only NSW residents are included. Rehabilitation episodes are excluded. Figures are based on where a person resides, rather than where they are treated. Hospital separations were classified using ICD-10-AM. Rates were age-adjusted using the Australian population as at 30 June 2001.
Patients treated solely within the emergency department are excluded from this indicator report due to a policy change (PD2017_015). Please note that a minority of patients being managed in short stay areas of emergency departments are still included. Further information is found in a paper in the HealthStatsPLUS Methods tab on this website.
Hospital episodes with source of referral being a transfer from another hospital or a type change admission were excluded in order to reduce multiple counting of hospitalisation episodes related to the same event. Hospital episodes with bed/unit type being hospital in the home were also excluded. Hospital episodes with a length of stay greater than 120 days were excluded to minimise the effect of outliers on estimated average and total bed days for conditions (episodes with length of stays greater than 120 days account for less than 0.01% of all potentially preventable hospitalisations).
Numbers for recent years include an estimate of the small number of hospitalisations of NSW residents in interstate public hospitals, data for which were unavailable at the time of production. Further details can be found in the Methods tab in the following HealthStats NSW indicator: http://www.healthstats.nsw.gov.au/Indicator/bod_hos_catLL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
Potentially Preventable Hospitalisations (PPH) are those conditions for which hospitalisation is considered potentially avoidable through preventive care and early disease management, usually delivered in an ambulatory setting, such as primary health care.
The term does not mean that a patient admitted for that condition did not need to be hospitalised at the time of admission. Rather, the hospitalisation may have been prevented by timely and appropriate provision of primary or community-based health care. Reducing hospitalisations might involve vaccination, early diagnosis and treatment, and/or good ongoing management of risk factors and conditions in community settings (see AIHW and Associated Information tab for detailed definition).
After July 2010, numbers and rates fell, affected by a significant change in coding standards for diabetes, a substantial contributor to total potentially preventable hospitalisations.
The increase in hospitalisations for vaccine-preventable conditions in 2013-14 and 2014-15 was largely driven by a change in Australian Coding Standards (ACS) for viral hepatitis in July 2013 which resulted in a substantial increase in the number of hospitalisations for different types of viral hepatitis, particularly Hepatitis B in this instance. For more information see Australian Consortium for Classification Development. The increase in hospitalisations for vaccine-preventable conditions was associated with this change and also due to an increase in hospitalisations for influenza and pneumonia.
Potentially preventable hospitalisations are included as a national performance indicator in the National HealthCare Agreement. The Australian Commission on Safety and Quality in Health Care is leading a national Potentially Preventable Hospitalisations Working Party to review the evidence for inclusion of each of the PPH conditions. This Working Party includes jurisdictional and clinical representatives and the Secretariat is provided by the AIHW. In January 2015, a new definition was published.
From May 2015 onwards, potentially preventable hospitalisation reporting on HealthStats NSW uses the National Health Care Agreement: P1 18-Selected potentially preventable hospitalisation definition.
Prior to 2015, the conditions included as the potentially preventable hospitalisations, or ambulatory care-sensitive conditions, are based on the set published by the Victorian Government Department of Human Services (VGDHS 2004) and subsequently reviewed by the Public Health Information Development Unit (Page et al. 2007).
Historically, the codes used to define potentially preventable hospitalisations in HealthStats differ slightly from those used in earlier editions of the Report of the Chief Health Officer, where they were referred to as ambulatory care sensitive conditions.
In 2006 in NSW the coding of diabetes was changed to include diabetes as a primary diagnosis only, which resulted in fewer cases of diabetes and therefore chronic conditions overall.
In 2007, urinary tract infections were included, which increased the number of cases in acute conditions category, and the coding of cellulitis was aligned with national standards.
In 2008, new codes covering gastroenteritis of infectious and unspecified origin were added following the expansion of the relevant ICD-10-AM codes and an accompanying change in coding practice. This resulted in an increase in the number of cases of the dehydration and gastroenteritis and consequently in the acute conditions category from 2008 and a break in continuity in that category.
Similarly, in 2010, new codes covering acute appendicitis were introduced replacing previously used codes. This resulted in a wider range of codes that had to be included in order to account for all cases of hospitalisation for perforated appendix, which is an ambulatory care sensitive condition. The number of cases included as the potentially preventable hospitalisations almost doubled in this category in the first year after the change.
After July 2010, PPH numbers and rates decreased significantly overall due to a change in the coding standards for diabetes which is a substantial contributor to total preventable hospitalisations. See the 'Codes tab' associated with any diabetes indicator for the discussion of details of this and other changes in diabetes coding.
Following each change in definition, data are recalculated for the entire span of years displayed in the report. The exception is the dehydration and gastroenteritis change in 2008 where a break in continuity occurred due to the introduction of new ICD-10-AM codes.
From 2015 onwards, HealthStats NSW uses the National Health Care Agreement: P1 18-Selected potentially preventable hospitalisation definition. The new PPH definitions apply from July 2007 nationally but, in HealthStatsNSW, the new definition applies to the whole period from 2001/02 onwards to allow for comparisons over time. The exception is the category ‘Other vaccine-preventable conditions’ which excludes‘Rotaviral enteritis-A08.0’ for years before 2006/07 as the vaccine was not on the national childhood immunisation schedule until 2007.
In 2016, HealthStats NSW applied two new exclusion rules to potentially preventable hospitalisatons. Hospital episodes with source of referral being a transfer from another hospital or a type change admission are excluded in order to reduce multiple counting of hospitalisation episodes relating to the same event. Hospital episodes with bed/unit type being hospital in the home are also excluded. These rules are applied to the whole period from 2001/02 onwards to allow for comparisons over time.
Australian Institute of Health and Welfare. Australian hospital statistics. Available at http://www.aihw.gov.au/hospitals/australian-hospital-statistics/
Victorian Government Department of Human Services. The Victorian Ambulatory Care Sensitive Conditions Study, 2001-02. Melbourne: VGDHS, 2004. Available at http://www.dhs.vic.gov.au/health/healthstatus/acsc/finalreport.htm
Page A, Ambrose S, Glover J, Hetzel D. Atlas of avoidable hospitalisations in Australia: ambulatory care-sensitive conditions. Adelaide: PHIDU, University of Adelaide and AIHW, 2007. Available at http://www.publichealth.gov.au/publications/atlas-of-avoidable-hospitalisations-in-australia%3a-ambulatory-care-sensitive-conditions.html
The NSW Combined Admitted Patient Epidemiology Data (CAPED) records all inpatient separations (e.g. discharges, transfers and deaths) from all public, private, psychiatric and repatriation hospitals in NSW, as well as public multi-purpose services, private day procedure centres and public nursing homes. The CAPED includes data on hospital admissions of NSW residents which occurred in public hospitals interstate.
In CAPED, public hospital data are recorded in terms of episodes of care. An 'episode of care' ends with the patient ending a period of stay in hospital (e.g. by discharge, transfer or death) or by becoming a different 'type' of patient within the same period of stay. For private hospitals, each CAPED record represents a complete hospital stay. CAPED records are counted based on the date of separation (discharge) from hospital.
Data from interstate hospitals for recent years may not yet be available when the data are analysed for publication. This may affect analyses and has a greater effect on rates for areas closer to an interstate boundary. Analyses by geographical regions and analyses involving uncommon diagnoses or procedures are particularly affected. Therefore, an estimate is made of interstate admissions for recent years of hospitalisations based on interstate admissions in the most recent year for which interstate data are available. Interstate admissions records from the most recent year for which interstate data are available are copied into the file for the most recent years, assuming that the attributes of these admissions (such as sex, age, geography, type of diagnosis or procedure) provide the best predictor of those for admissions in the recent years.
|Vaccine preventable conditions|
|Pneumonia and influenza (vaccine-preventable)||J10, J11, J13, J14||
In any diagnosis. Exclude people under 2 months. Rehabilitation records are excluded.
|Other vaccine-preventable conditions||A08.0, A35, A36, A37, A80, B01, B05, B06, B16.1, B16.9, B18.0, B18.1, B26, G00.0||
In any diagnosis. Rotaviral Enteritis (A08.0) included for records with separation date 1 July 2007 onwards. Rehabilitation records are excluded.
As principal diagnosis. Exclude children aged less than 4 years. Rehabilitation records are excluded.
|Congestive cardiac failure||I50, I11.0, J81||
As principal diagnosis. Exclude cases with the following cardiac procedure codes: Blocks 600-606, 608-650, 653-657, 660-664, 666, 669-682, 684-691, 693, 705-707, 717 and codes 33172-00, 33827-01, 34800-00, 35412-00, 38721-01, 90217-02, 90215-02. Rehabilitation records are excluded.
|Diabetes complications||E10, E11, E13, E14||As principal diagnosis. Rehabilitation records are excluded.|
|COPD||J20, J41, J42, J43, J44||
J41-J44 as principal diagnosis. J20 as principal diagnosis with additional diagnoses of J41, J42, J43, J44. Rehabilitation records are excluded.
As principal diagnosis. J20 only with additional diagnosis of J47. Rehabilitation records are excluded.
|Angina||I20, I24.0, I24.8, I24.9||
As principal diagnosis. Exclude cases according to the list of procedures excluded from the Congestive cardiac failure category above. Rehabilitation records are excluded.
|Iron deficiency anaemia||D50.1, D50.8, D50.9||As principal diagnosis. Rehabilitation records are excluded.|
As principal diagnosis.Exclude cases with procedure codes according to the list of procedures excluded from the Congestive cardiac failure category above. Rehabilitation records are excluded.
|Nutritional deficiencies||E40, E41, E42, E43, E55.0, E64.3||As principal diagnosis. Rehabilitation records are excluded.|
|Rheumatic heart diseases||I00, I01, I02, I05, I06, I07, I08, I09||As principal diagnosis. Rehabilitation records are excluded.|
|Pneumonia (not vaccine-preventable)||J15.3, J15.4, J15.7, J16.0||
In any diagnosis. Exclude people under 2 months. Rehabilitation records are excluded.
|Urinary tract infections, including pyelonephritis||N10, N11, N12, N13.6, N15.1, N15.9, N28.9, N39.0, N39.9||As principal diagnosis. Rehabilitation records are excluded.|
|Perforated/bleeding ulcer||K25.0, K25.1, K25.2, K25.4, K25.5, K25.6, K26.0, K26.1, K26.2, K26.4, K26.5, K26.6, K27.0, K27.1, K27.2, K27.4, K27.5, K27.6, K28.0, K28.1, K28.2, K28.4, K28.5, K28.6||As principal diagnosis. Rehabilitation records are excluded.|
|Cellulitis||L02, L03, L04, L08, L88, L98.0, L98.3||
As principal diagnosis. Exclude cases with any procedure except those in blocks 1820 to 2016, or if procedure is 30216-00, 30216-01, 30216-02, 30676-00, 30223-01, 30223-02, 30064-00, 90660-00, 90661-00, and this is the only listed procedure. Rehabilitation records are excluded.
|Pelvic inflammatory disease||N70, N73, N74||As principal diagnosis. Rehabilitation records are excluded.|
|Ear, nose and throat infections||H66, J02, J03, J06, J31.2||As principal diagnosis. Rehabilitation records are excluded.|
|Dental conditions||K02, K03, K04, K05, K06, K08, K09.8, K09.9, K12, K13, K14.0||As principal diagnosis. Rehabilitation records are excluded.|
|Convulsions and epilepsy||G40, G41, R56||As principal diagnosis. Rehabilitation records are excluded.|
|Eclampsia||O15||As principal diagnosis. Rehabilitation records are excluded.|
|Gangrene||R02, I70.24, E09.52||R02 in any diagnosis. I70.2 and E09.52 as principal diagnosis. Rehabilitation records are excluded.|
Based on National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2017. In HealthStats NSW, ‘In any diagnosis’ uses 51 diagnosis fields.
• The rate of potentially preventable hospitalisations was 2,141.6 per 100,000 population in 2018-19.
• Rates of potentially preventable hospitalisations remained stable between 2001-02 and 2009-10, but decreased by about 7% between 2009-10 and 2010-11. This was due to a significant change in coding standards for diabetes, which is a substantial contributor to chronic and total preventable hospitalisations, in July 2010. The change caused a 60% decrease in the number of hospitalisations where diabetes with complications was coded as a principal diagnosis in 2010-11. The trend has been slowly increasing since 2010-11, associated mainly with acute conditions and an increase in hospitalisations for vaccine-preventable conditions in 2013-14 and 2014-15, largely driven by a change in Australian Coding Standards for viral hepatitis in July 2013 and an increase in hospitalisations for influenza and pneumonia in 2014-15 and 2017-18.
• The age-adjusted rate of admission for potentially preventable hospitalisations for Aboriginal people in 2018-19 was 4,949 per 100,000 population compared with 2,032 per 100,000 population for non-Aboriginal people (2.4 times higher for Aboriginal people). There are a number of reasons why the rate for Aboriginal people has increased in recent years, including a 10% improvement in the reporting of Aboriginal people in NSW hospital data since 2009-10 and the implementation of programs to improve access to health services by Aboriginal people in response to a higher health need.
• Cellulitis, chronic obstructive pulmonary disease (COPD), urinary tract infections (including pyelonephritis), dental conditions, ear, nose and throat infections and congestive heart failure account for over half of all potentially preventable hospitalisations in NSW.
• Diabetes with complications was ranked first among individual conditions collectively comprising total potentially preventable hospitalisations in 2009-10. After the change in coding standards in July 2010 diabetes has remained around the ninth ranking since this time.
• The rate of potentially preventable hospitalisations increases with geographic remoteness and with increasing disadvantage, a pattern that is consistent over time. These gradients may reflect differences in access to primary health care, differences in the prevalence of disease in population subgroups, as well as urban and rural differences in hospital admission practices. Rates are also consistently higher among Aboriginal people in NSW compared with non-Aboriginal people.
Potentially preventable hospitalisations (PPH) are included as a national performance indicator in the National Healthcare Agreement. The Australian Commission on Safety and Quality in Health Care is leading a national Potentially Preventable Hospitalisations Working Party to review the evidence for inclusion of each of the PPH conditions. This Working Party includes jurisdictional and clinical representatives and the Secretariat is provided by the Australian Institute of Health and Welfare.
Potentially preventable hospitalisation reporting on HealthStats NSW uses the National Healthcare Agreement: PI 18–Selected potentially preventable hospitalisations, 2017 definition.
Potentially preventable hospitalisations for chronic conditions
The most common chronic conditions defined as potentially preventable hospitalisations or ambulatory care sensitive hospitalisations are included in the NSW Severe Chronic Disease Management Program.
In response to the Garling Report 2008, the NSW Ministry of Health started implementing the NSW Chronic Disease Management Program. Currently, this program is being overseen by the NSW Agency for Clinical Innovation. It aims to improve the quality of life of older people with chronic and complex conditions, their carers and families and to prevent unplanned and avoidable hospital admissions. It achieves this by coordinating a statewide chronic disease management approach.
The NSW Chronic Disease Management Program is described at: http://www.health.nsw.gov.au/cdm/pages/default.aspx.
Potentially preventable hospitalisations for vaccine preventable conditions
The NSW Immunisation Program provides the community of NSW with protection against vaccine preventable diseases through initiatives targeting infants, children, adolescents, healthcare workers and older people. For more information see: http://www.health.nsw.gov.au/immunisation/pages/default.aspx