Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Tier 3—Effective/appropriate/efficient—3.07 Selected potentially preventable hospital admissions
Why is it important?:Analysis of the conditions for which people are admitted to hospital reveals that in many cases, the hospital admission could have been prevented through timely and effective care outside of hospital (Li et al. 2009b). Hospitalisations for conditions that are sensitive to the effectiveness, timeliness and adequacy of non-hospital care are referred to as potentially preventable hospital admissions. This includes conditions for which hospitalisation could potentially be avoided through effective preventive measures or early diagnosis and treatment (Page et al. 2007). The list of conditions for which hospitalisation is potentially preventable is subject to debate (Li et al. 2009b) and is reviewed from time to time in Australia to reflect advances in health care.
Potentially preventable conditions are usually grouped into three categories:
- vaccine-preventable conditions—including invasive pneumococcal disease, influenza, tetanus, measles, mumps, rubella, pertussis, and polio;
- potentially preventable acute conditions—including dehydration/gastroenteritis, kidney infection, perforated ulcer, cellulitis, pelvic inflammatory disease, dental conditions, and ear, nose and throat infections; and
- potentially preventable chronic conditions—including diabetes, asthma, angina, hypertension, congestive heart failure, and chronic obstructive pulmonary disease.
Findings:In the two-year period from July 2008 to June 2010, rates for potentially preventable hospital admissions were five times as high for Aboriginal and Torres Strait Islander peoples compared with non-Indigenous Australians. Potentially preventable hospital admissions (excluding those for dialysis) accounted for 26% of all hospital admissions for Indigenous Australians. Differences in hospitalisation rates between Indigenous and non-Indigenous Australians were particularly striking for older age groups.
For Indigenous Australians, vaccine-preventable conditions accounted for around 3% of all ambulatory care sensitive hospital admissions, acute conditions for 33% of admissions and chronic conditions for 64% of admissions. The majority of these hospitalisations were due to diabetes complications (48%). Other significant conditions included convulsions/epilepsy, chronic obstructive pulmonary disease, dental conditions, and ear, nose and throat infections. For children, the most common conditions were dental conditions, and ear, nose and throat infections, while for adults, diabetes complications were the most prevalent.
Compared with non-Indigenous Australians, hospitalisation rates for selected potentially preventable conditions were around 10 times as high for Aboriginal and Torres Strait Islander peoples living in remote areas, four times as high in major cities and regional areas, and three times as high in very remote areas. Potentially preventable hospitalisations for Indigenous Australians living in remote areas represented a higher proportion of all hospitalisations (39%) than nationally (26%).
Indigenous hospitalisation rates for vaccine-preventable diseases have decreased significantly since 1998–99 in Qld, WA, SA and the NT combined, although there has been no significant change since 2004–05 in NSW, Victoria, Qld, WA, SA and the NT combined. Due to changes in coding since 2007–08, resulting in an apparent decline for diabetes complication and increase for gastroenteritis, time-series data are not currently available for hospitalisation rates for chronic and acute conditions under this performance measure.Top of Page
Implications:Long-term declines in rates of vaccine-preventable ambulatory care-sensitive conditions are likely to be linked to improvements in the coverage of childhood and adult immunisation (see measure 3.02). The main challenges are to address gaps in coverage (e.g., in Aboriginal and Torres Strait Islander adults over 40 years receiving influenza and pneumococcal vaccines).
The most common conditions within the acute group included dental and ear, nose and throat infections. Dental care access issues have been discussed elsewhere in this report (see measure 3.14). The majority of hospitalisations for ear, nose and throat infections occurred in the 0–14 year age group, where rates were twice the non-Indigenous rate. Analysis of data on ear/hearing problems for this age group found self reported prevalence rates three times the non-Indigenous rate, yet GP consultations only 1.2 times as high (see measure 1.15).
Hospitalisation rates for potentially preventable chronic conditions were seven times as high for Indigenous Australians compared with non-Indigenous Australians. The major conditions within the chronic group were diabetes complications, chronic obstructive pulmonary disease, and asthma. These high rates reflect the higher rate of chronic conditions in the population and the need to strengthen services that intervene earlier in the disease process, including prevention, early detection, and improved chronic disease management (Li et al. 2009b).
A number of studies have found that improving patient provider communication and collaboration makes it easier for people to navigate, understand and use information and services to take care of their health e.g., matching information to the patient’s needs and abilities, recognising the importance of asking questions, shared decision making, and providing a range of avenues for communication (Øvretveit 2012; Hernandez et al. 2012).
Through the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, Australian governments have agreed to improve Indigenous Australians’ access to effective and comprehensive primary and preventative health care. This Agreement aims to reduce potentially avoidable hospitalisations for Indigenous Australians through the prevention, early detection and management of chronic disease.
In Victoria the Improving care for Aboriginal and Torres Strait Islander Patients Program aims to reduce preventable hospital re-admissions by providing high quality and culturally responsive referrals, treatment and discharge planning.
Governments have also agreed under National Health Reform, that Australia’s health system should provide all Australians with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.Top of Page
Figure 161—Hospitalisations for ambulatory care sensitive conditions, by Indigenous status and remoteness, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Source: AIHW Analysis of National Hospital Morbidity DatabaseTop of Page
Figure 162—Hospitalisation rates for ambulatory care sensitive hospital admissions, by Indigenous status and age group, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Source: AIHW Analysis of National Hospital Morbidity DatabaseTop of Page
Figure 163—Top 10 ambulatory care sensitive hospital admissions, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
*An inflammation of the kidney and upper urinary tract
Source: AIHW Analysis of National Hospital Morbidity Database