|
|
|
Select the rows below to view more detail on a method
Potentially preventable hospitalisations and ambulatory care sensitive conditions
The method used to calculate potentially preventable hospitalisations (PPHs) in this report uses the concept of ambulatory care-sensitive (ACS) conditions.
Origin of the definition used in this report
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).
Changes in the definition in NSW over time
The codes used to define potentially preventable hospitalisations in this report differ slightly from those used in earlier editions for the Report of the Chief Health Officer (where they were called: 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 2010, 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 in the acute conditions category from 2008 and a break in continuity in that category.
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 sue to the introduction of new ICD-10-AM codes.
The ICD-9-CM and ICD-10-AM codes used can be found in the Codes tab.
Definitions used by the AIHW
The Australian Institute of Health and Welfare publishes Australia-wide statistics on potentially preventable hospitalisations or ambulatory care sensitive conditions (ACS) in their annual publication Australian hospital statistics (AIHW Health services series no. 17. Cat. no. HSE 84 2010). The statistics include state data, however direct comparison with the NSW results for total potentially preventable hospitalisations or ambulatory care sensitive conditions with those published in this report is not possible due to the differences in the definition of diabetes used by the AIHW. The results for other conditions can be compared.
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.
References
Australian Institute of Health and Welfare. Australian hospital statistics 2008–09. Health services series no. 17. Cat. no. HSE 84. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publications/hse/84/11173.pdf (Cited in September 2010).
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
Select the rows below to view more detail on a code
The International Statistical Classification of Diseases and Related Health Problems
National Centre for Classification in Health, Australia; CM - Clinical Modification; AM - Australian Modification
| Description | ICD-9 & ICD-9-CM | ICD-10 & ICD-10-AM | Comments |
|---|---|---|---|
| Vaccine-preventable | |||
| Influenza and pneumonia | 481, 482.2, 482.3, 482.9, 483, 487.0, 487.1, 487.8 | J10, J11, J13, J14, J15.3, J15.4, J15.7, J15.9, J16.8, J18.1, J18.8 | In any diagnosis field (1-5); exclude people under 2 months; ICD-9-CM: exclude cases with secondary diagnosis of 282.6; ICD-10-AM: exclude cases with secondary diagnosis of D57 |
| Other vaccine preventable | 032, 033.0, 033.1, 033.8, 033.9, 037, 045, 055, 056, 070.3, 072, 320.0 | A35, A36, A37, A80, B05, B06, B16.1, B16.9, B18.0, B18.1, B26, G00.0, M01.4 | In any diagnosis field (1-5) |
| Chronic | |||
| Diabetes complications | 250.1-250.9 | E10.0-E10.8, E11.0-E11.8, E12.0- E12.8, E13.0-E13.8, E14.0-E14.8 | Principal diagnosis only |
| Nutritional deficiencies | 260, 261, 262, 268.0, 268.1 | E40-E43, E55.0, E64.3 | Principal diagnosis only |
| Iron deficiency anaemia | 280.1, 280.8, 280.9 | D50.1-D50.9 | Principal diagnosis only |
| Hypertension | 401.0, 401.9, 402.00, 402.10, 402.90 | I10, I11.9 | Principal diagnosis only; ICD-9-CM: exclude cases with procedure code of 35, 36, 37.5, 37.6, 37.7, 37.8; ICD-10-AM: exclude cases with procedures in blocks 600-693, 705-707, 717 and procedure codes 38721-00, 38721-01, 90226-00 |
| Congestive heart failure | 402.01, 402.11, 402.91, 428, 518.4 | I11.0, I50, J81 | Principal diagnosis only; ICD-9-CM: exclude cases with procedure code of 35, 36, 37.5, 37.6, 37.7, 37.8; ICD-10-AM: exclude cases with procedures in blocks 600-693, 705-707, 717 and procedure codes 38721-00, 38721-01, 90226-00 |
| Angina | 411.1, 411.8, 413 | I20, I24.0, I24.8, I24.9 | Principal diagnosis only; ICD-9-CM: exclude cases with procedure codes 01 to 86.99; ICD-10-AM: exclude cases with procedure codes in blocks 1-1779 |
| Chronic obstructive pulmonary disease | 491, 492, 494, 496, (466.0) | J41-J44, J47, (J20) | Principal diagnosis only; ICD-9-CM: 466.0 only with secondary diagnosis of 491, 492, 494, 496; ICD-10-AM: J20 only with secondary diagnosis of J41, J42, J43, J44, J47 |
| Asthma | 493 | J45, J46 | Principal diagnosis only |
| Acute | |||
| Dehydration and gastroenteritis | 276.5, 558.9 | E86, K52.2, K52.8, K52.9 and from 1 July 2008: A09.9 | Principal diagnosis only |
| Convulsions and epilepsy | 345, 642.6, 780.3 | G40, G41, O15, R56 | Principal diagnosis only |
| Ear, nose and throat infections | 382, 462, 463, 465, 472.1 | H66, H67, J02, J03, J06, J31.2 | Principal diagnosis only |
| Dental conditions | 521, 522, 523, 525, 528 | K02-K06, K08, K09.8, K09.9, K12, K13 | Principal diagnosis only |
| Perforated/bleeding ulcer | 531.0-531.2, 531.4-531.6, 532.0-532.2, 532.4-532.6, 533.0-533.2, 533.4-533.6, 534.0-534.2, 534.4-534.6 | K25.0- K25.2, K25.4-K25.6, K26.0-K26.2, K26.4-K26.6, K27.0-K27.2, K27.4-K27.6, K28.0-K28.2, K28.4-K28.6 | Principal diagnosis only |
| Ruptured appendix | 540 | K35.0 | In any diagnosis field (1-5) |
| Urinary tract infections including pyelonephritis | 590.0, 590.1, 590.8 | N10, N11, N12, N13.6, N39.0 | Principal diagnosis only |
| Pelvic inflammatory disease | 614 | N70.0, N70.1, N70.9, N73, N74.0-N74.1, N74.2-N74.8 | Principal diagnosis only |
| Cellulitis | 681, 682, 683, 686 | L03, L04, L08, L88, L98.0, L98.3 | Principal diagnosis only; ICD-9-CM: exclude cases with procedure codes 01 to 86.99 except 86.0 where it is the only listed procedure; ICD-10-AM: exclude cases when any procedure performed from blocks 1-1779 except when the following procedures done as the only ones: blocks: 1604-1606, 1608 and procedures: 90660-00, 30207-00, 30676-00, 30679-00, 34530-01 and 47912-00. |
| Gangrene | 785.4 | R02 | In any diagnosis field (1-5) |
Download the indicator content
|
Add indicator content to My Report
|
||||||||||||||||||||
Download the data
|
Download the associated information
Commentary on topics
linked to this indicator |
||||||||||||||||||||
Download the graph image
|
Related Indicators
• Hospitalisation rates for Potentially Preventable Hospitalisations, also called Ambulatory Care Sensitive Conditions, have increased by less than 10% over the 20 years up to 2009-10.
• After July 2010, there was a significant change in coding standards for diabetes, which is a substantial contributor to Chronic and total Preventable Hospitalisations. This change caused a decrease in number of hospitalisations where diabetes with complications was coded in principal diagnosis by 60% in 2010-11 and the rates of hospitalisation for all PPH decreased by about 7% between 2009-10 and 2010-11.
• Hospitalisation rates for Vaccine-preventable conditions decreased by over 70% over the last 20 years.
• Dehydration and gastroenteritis, chronic obstructive pulmonary disease (COPD), selected urinary tract infections (pyelonephritis and site unspecified), dental conditions and cellulitis accounted for over half (51%) of all Potentially Preventable Hospitalisations in NSW during the financial year 2010-11.
• Diabetes with complications were the most substantial contributor to total Potentially Preventable Hospitalisations in 2009-10, after the change in coding standards in July 2010 diabetes with complications dropped to the eleventh place (from around 310 hospitalisations per 100,000 in 2009-10 to around 120 in 2010-11).
• In 2008-09 the potentially preventable hospitalisation rates in NSW were the third lowest in Australia, after Tasmania and the Australian Capital Territory.
• Rates for potentially preventable hospitalisations increase with increasing geographic remoteness. The relative differences between areas are much greater than between the rates for all other hospitalisations.
• Rates for potentially preventable hospitalisations in the lowest SES group increased significantly in the last decade. Since the rates have been stable in other groups, both the relative and absolute gaps in rates between the lowest SES group and the rest of the population have increased over this period.
Definition of potentially preventable hospitalisations (PPHs)
There are several ways in which potentially preventable hospitalisations may be defined. In this report, potentially preventable hospitalisations are defined as hospitalisations for ambulatory care sensitive conditions. This is consistent with the defintion used at the national level by the Australian Institute for Health and Welfare (AIHW) for this indicator in the National HealthCare Agreement.
Definition of potentially preventable hospitalisations or ambulatory care sensitive conditions
Potentially preventable hospitalisations or ambulatory care sensitive conditions are those 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 (for example by general practitioners or community health centres).
Rates for potentially preventable hospitalisations or ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. Other factors that influence these rates include disease prevalence in the community, hospital admission and coding practices, and personal choices about seeking health care. The conditions reported here as ambulatory care sensitive are presented in three categories: vaccine-preventable conditions, acute conditions and chronic conditions.
Categories and conditions classified as potentially preventable hospitalisations or ambulatory care sensitive
Three categories of potentially preventable hospitalisations or ambulatory care sensitive conditions are commonly used to group conditions:
Vaccine-preventable conditions: including influenza, bacterial pneumonia, tetanus, measles, mumps, rubella, pertussis and polio-conditions. These conditions should be preventable though immunisation which is usually administered in a primary healthcare setting.
Acute conditions: including dehydration and gastroenteritis, kidney and other urinary tract infections, perforated ulcer, cellulitis, pelvic inflammatory disease, ear nose and throat infections, dental conditions, appendicitis, convulsions and epilepsy and gangrene. Although these conditions may not be preventable, hospitalisation may theoretically be avoided through timely access to primary care.
Chronic conditions: including diabetes with complications, asthma, angina, hypertension, congestive heart failure, chronic obstructive pulmonary disease and iron deficiency anaemia and nutritional deficiencies. These conditions can theoretically be managed in a primary health setting through through behaviour modification, lifestyle change and medical treatment of symptoms, to prevent deterioration and hospitalisation.
A comparison of rates for individual conditions defined as potentially preventable or ambulatory care sensitive provides an indication of the relative burden that they contribute. The measures of total bed days and average bed days (total bed-days/total ambulatory care sensitive hospitalisations) provide an indication of the relative severity and burden of each condition.
Definitions used internationally and nationally
While other countries utilise the concept of ambulatory care sensitive conditions, there is no agreed definition used internationally. Many jurisditions in Australia use the concept and similar definitions, with the main variation occurring for diabetes complications (Page et al. 2007).
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.
The ICD-10 and ICD-9 codes currently used for defining ambulatory care sensitive conditions in NSW are included in the table under the Codes tab.
Potentially preventable hospitalisations or ambulatory care sensitive conditions in NSW
Rates for potentially preventable hospitalisations or ambulatory care sensitive conditions have increased in NSW over the 20 years up to 2008-09 by over 9%, but hospitalisation for vaccine-preventable conditions dropped by almost 60% in the same period.
References
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
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 Department of Health is implementing the NSW Severe Chronic Disease Management Program. This program is being overseen by the Chronic Disease Management Office 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 Severe Chronic Diseases Management Program is focused on five major chronic diseases of interest that are recognised as having a major impact on the burden of disease in NSW. Furthermore, these conditions have been demonstrated to have improved outcomes through CDM approaches. The diseases of interest are Chronic Obstructive Pulmonary Disease (mainly emphysema and chronic bronchitis); Coronary Artery Disease (also known as coronary or ischaemic heart disease); Diabetes; Hypertension (high blood pressure); and Congestive Heart Failure.
People who are diagnosed with these diseases and who are experiencing repeated episodes in hospital are offered enrolment to the program. In the future the program will expand and be offered to people with these conditions even if they are not being admitted to hospital frequently to prevent their deterioration.
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.
The Program involves coordinated efforts by the NSW Department of Health, health services, general practice, local government, educational authorities and Aboriginal Controlled Community Health Organisations. The Program is undertaken in accordance with the requirements of the National Immunisation Program, through which the Australian Government provides funds to NSW for the purchase of vaccines.
Useful websites include:
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
HealthInsite at http://www.healthinsite.gov.au
Public Health Information Development Unit at the University of Adelaide at http://www.publichealth.gov.au