NACCHO Aboriginal Health News: Interactive spotlight on areas with most preventable hospitalisations

aboriginal-woman-at-dialysis

People living in some areas in Australia are nine times more likely than others to be admitted to hospital for a condition that could have been more effectively treated in the community by GPs or other health workers, a new National Health Performance Authority report shows.

Measuring ‘potentially preventable hospitalisations’ provides important insights into how well health systems are performing in keeping Australians healthy and out of hospital. The report finds that across more than 300 local areas called Statistical Areas Level 3 (SA3s) in 2013–14, the rate of these potentially preventable hospitalisations varied from as few as 1,400 hospitalisations per 100,000 people in one area, to as many as 12,700 per 100,000 people in another – even after adjusting for differences in the age of people across local areas.

The new report is the Performance Authority’s second that looks at the number and population rate of potentially preventable hospitalisations in public and private hospitals in local areas across the country. As some conditions tend to require longer stays in hospital than others, the report also states the numbers of hospital bed days that each of the conditions accounts for in each geographic area.

Nationally, there were 600,276 admissions in 2013–14 for the 22 conditions for which hospitalisation has been agreed by all governments as being potentially preventable, accounting for 6% of the total of 9.7 million hospital admissions in that year. These 600,276 potentially preventable hospitalisations also accounted for about 2.4 million bed days, nearly 8% of the total number of bed days across Australia.

For the first time, this new report focuses on a subset of five of the 22 conditions that accounted for almost half of all potentially preventable hospitalisations and nearly two-thirds of hospital bed days for these conditions in 2013–14 – allowing local areas to identify with greater precision which conditions could most benefit from different models of care.

The report finds:

  • Across local areas (SA3s), potentially preventable hospitalisations ranged from 1,406 hospitalisations per 100,000 people in Pennant Hills-Epping (NSW) to 12,705 per 100,000 people in Barkly (NT)
  •  Across similar local areas in major cities with lower socioeconomic status, the rate of potentially preventable hospitalisations varied more than two-fold, ranging from 1,800 hospitalisations per 100,000 people in Hurstville (NSW) to 4,062 per 100,000 in Mount Druitt (NSW)
  • Across all 31 Primary Health Network (PHN) areas, hospitalisation rates for each of the five conditions ranged markedly: for COPD, from 112 hospitalisations per 100,000 people in Northern Sydney to 600 per 100,000 in the Northern Territory; while for cellulitis, rates ranged from 149 hospitalisations per 100,000 people in Perth North to 696 per 100,000 in Western Queensland.

Performance Authority CEO Dr Diane Watson said the fact that hospitalisations for a specific condition had been classified as potentially preventable did not mean a person admitted to hospital for one of those conditions did not need to be hospitalised at the time.

“Rather, it indicates that the admission may have been prevented by timely access to adequate primary health care to prevent the condition, or that the condition once developed could have been better treated in the community,” Dr Watson said.

To assist PHNs and health decision-makers to target improvements in their community, one-page ‘result profiles’ for each PHN area are included in the report that help spotlight which conditions are responsible for the most hospitalisations in their communities.

Additionally, a new interactive web tool has been launched on the

MyHealthyCommunities website

that allows users to easily search results for their community across all 22 conditions.

The full list of the 22 conditions for which hospitalisation is considered potentially preventable is located at Attachment A.

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 What where and when Aboriginal Health

One comment on “NACCHO Aboriginal Health News: Interactive spotlight on areas with most preventable hospitalisations

  1. Thanks NACCHO for sending this notice out! The NHPA have produced a valuable report but it does not quite go far enough. High rates of potentially preventable hospitalizations are influenced by the disproportionately high rate of illness affecting Aboriginal peoples and their poor access to primary health care- the report falls short of highlighting this for PHNs.
    In the Technical Supplement, authors note that subgroups analyses were unlikely to be reliable due to incomplete recording of Indigenous status in the Admitted Patient Care Database. I am not sure this is convincing and wonder if this decision was appropriately informed (ie judicious decisions about pros and cons and caveats, with Aboriginal informants). Incomplete recording is an ongoing problem, but it hasn’t stopped the AIHW from making inferences in their reports.

    Moreover, the authors of the technical supplement report that estimated resident population data for Aboriginal peoples at PHN or SA3 geographical areas was unavailable. This is also unconvincing given easy access to PHN Indigenous and non-Indigenous population numbers from the AIHW as well as in the public domain (ABS Census quick stats for SA3 areas; http://www.aihw.gov.au/indigenous-australians/indigenous-health-check-data-tool/ for Indigenous population by PHN).

    On page 10 of the report, the authors state the following:
    “Remoteness and lower socioeconomic status are also factors that influence rates. However, the report also shows large variation in age-standardised rates of potentially preventable hospitalisations across areas that are similar in terms of remoteness and socioeconomic status.”

    It would have been a good opportunity for the authors to propose that one explanation for the variability in PPH (from low to high rates) given similar remoteness levels and SES status might be related to the distribution of the Aboriginal population within those SA3 areas with high rates of illness and poor acess to PHC.
    For example:
    1. The % of Aboriginal people in Barkly NT (>50%) is very different from that of Esperance WA (3.9%). Barkly NT and Esperence are both remote areas, yet the rate of PPH is substantially different, being much much higher in Barkly.
    2. The % Aboriginal people in Mt Druitt is 6%, the % Aboriginal in Hurstville NSW is: 0.6%. Both regions are in lower SES regions of major cities, but Mt Druitt has much higher rate of PPH than Hurstville.
    3. In Maryborough Qld – the proportion Aboriginal is 3.8%, compared with 0.7% in the Macedon Ranges. Maryborough has higher rates of PPH than Macedon Ranges even though both regions are classified as inner regional.
    4. Western Queensland PHN has higher levels of PPH than other PHNs but a comparison of SA3 areas within PHNs tells a different story. Part of this is explained by the higher distribution of Aboriginal peoples within SA3 regions with high PPH rates.

    It is vital that reports produced by the NHPA draw policy makers and health providers attention to these disproportions in order to divert program effort and resourcing to where it can make the most difference- Aboriginal primary health care services and programs (community-controlled).

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