Notes on the data: Aboriginal hospital admissions

Aboriginal admissions by selected principal diagnosis (including by sex and by broad age group); and from potentially preventable conditions (including by vaccine-preventable, acute and chronic, and by broad age group), 2012/13 to 2014/15

 

Policy context:  Admission to hospital is a formal process, and follows a decision made by an accredited medical practitioner at that hospital that a patient needs to be admitted for appropriate management or treatment of their condition, or for appropriate care or assessment of needs [1].

Patients are usually admitted to hospital either as an emergency or as a booked admission. Emergency admission patients are usually admitted through the Accident and Emergency Department: these are seriously injured or ill patients who need immediate treatment. Most patients receive hospital-based services as a booked (elective) admission, either as a same-day patient or an inpatient. A same-day patient comes to hospital for a test or treatment and returns home the same day. An overnight admission is recorded where a patient receives hospital treatment for a minimum of 1 night (that is, the patient is admitted to and separated from the hospital on different dates) or longer in the hospital.

The majority of people who have had an episode of care in a hospital express satisfaction with the service when they leave [1]. However, admission to hospital carries with it a risk of harm. In Australia rates of serious adverse medical events are similar to those found in studies in the United States, with 0.3% of hospital admissions associated with an iatrogenic (medically caused) death and 1.7% associated with major iatrogenic disability [2]. Admission to hospital per se also carries a risk of adverse events, in addition to those related to any medical treatment undertaken. These include a risk of cross-infection, injury, or rarely, death.

In 2014–15, Aboriginal and Torres Strait Islander people had higher separation rates than that for other Australians. Separation rates for Indigenous Australians were at least twice the rates for other Australians for Factors influencing health status and contact with health services (which includes Care involving dialysis, with 12 times the rate for other Australians); Diseases of the respiratory system, Endocrine, nutritional and metabolic diseases (which includes Diabetes mellitus); Diseases of the skin and subcutaneous tissue; and Certain infectious and parasitic diseases [1].

References

  1. Australian Institute of Health and Welfare 2016. Admitted patient care 2014–15: Australian hospital statistics. Health services series no. 68. Cat. no. HSE 172. Canberra: AIHW.
  2. Runciman WB, Webb RK, Helps SC et al. A comparison of iatrogenic injury studies in Australia and America II: reviewer behaviour and quality of care. The International Journal of Quality in Healthcare 2000;12(5):379-88.
 

Notes:  

Introduction

Where used, the terms ‘Aboriginal’ and ‘Indigenous Australians’ refer to Aboriginal and Torres Strait Islander people.

The data presented are of the number of separations, or completions of the episode of care of a patient in hospital, where the completion can be the discharge, death or transfer of the patient, or a change in the type of care (e.g., from acute to rehabilitation). In this atlas the term 'admission' is used in place of the technically-correct 'separation'. As these data relate to short-term episodes of care, and not to long-stay episodes, the number of admissions is similar to the number of separations in any year.

Potentially preventable hospitalisations are admissions from a specified range of conditions where hospitalisation could have been potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community-based care settings (including by general practitioners, medical specialists, dentists, nurses and allied health professionals). The potentially preventable conditions are as defined in National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2016 and are classified as vaccine preventable, chronic and acute (for further information see item at Reference [1], above).

Note that the data are based on the count of all admissions. As such, repeat admissions for one person are counted as separate admissions. In addition, patients admitted to one hospital and transferred to another hospital are counted as separate admissions. Although such transfers occur in all areas, they are likely to be more prevalent from regional to metropolitan areas, thereby resulting in a higher rate of admissions in regional areas compared to the metropolitan areas; in addition, certain conditions are more likely to result in transfers.

Caution should be used in the interpretation of these data because of jurisdictional differences in data quality as well as under-identification of Aboriginal and Torres Strait Islander people. The AIHW found that nationally, about 88% of Indigenous Australians were identified correctly in hospital admissions data in the 2011–12 study period, and the ‘true’ number of separations for Indigenous Australians was about 9% higher than reported (for further information see item at Reference [1], above).

Exclusions

The national data exclude well babies (i.e., babies not admitted for acute care) who are nine days old or less, other than the second or subsequent live born infant of a multiple birth whose mother is currently an admitted patient (for further information see item at Reference [1], above).

Same-day admissions for dialysis for kidney disease have been excluded from the data in this atlas for the categories of admissions for males, females and total persons, and admissions by age. These admissions have been excluded as they represent many repeat visits by a relatively small number of patients, who may have multiple admissions in a week: their inclusion can dramatically alter the geographic distribution of other categories of admissions (see the separate note for Same-day hospital admissions for renal dialysis, Aboriginal personsfor further details); these data are presented separately. All other same-day admissions are included.

Details of data presented

Refer to separate note for Same-day hospital admissions for renal dialysis, Aboriginal persons

Separate data are presented for:

1. Admissions by sex (excluding same-day admissions for renal dialysis):

  • Total admissions, Aboriginal persons
  • Male admissions, Aboriginal males
  • Female admissions, Aboriginal females

2. Admissions by age (excluding same-day admissions for renal dialysis):

  • Total admissions, Aboriginal persons aged 0 to 14 years
  • Total admissions, Aboriginal persons aged 15 to 24 years
  • Total admissions, Aboriginal persons aged 25 to 44 years
  • Total admissions, Aboriginal persons aged 45 to 64 years
  • Total admissions, Aboriginal persons aged 65 years and over
  • Total admissions, Aboriginal persons aged 15 years and over

3. Admissions by selected principal diagnosis:

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters.

  • Admissions for infectious and parasitic diseases (A00-B99), Aboriginal persons
  • Admissions for all cancers (C00-D48), Aboriginal persons
  • Admissions for blood and blood-forming organ diseases and certain disorders involving the immune mechanism (D50-D89), Aboriginal persons
  • Admissions for endocrine, nutritional and metabolic diseases (E00-E90), Aboriginal persons
  • Admissions for mental health related conditions (F00-F99), Aboriginal persons
  • Admissions for nervous system diseases (G00-G99), Aboriginal persons
  • Admissions for eye and adnexa diseases (H00-H59), Aboriginal persons
  • Admissions for ear and mastoid process diseases (H60-H95), Aboriginal persons
  • Admissions for circulatory system diseases (I00-I99), Aboriginal persons
  • Admissions for respiratory system diseases (J00-J99), Aboriginal persons
  • Admissions for digestive system diseases (K00-K93), Aboriginal persons
  • Admissions for skin and subcutaneous tissue diseases (L00-L99), Aboriginal persons
  • Admissions for musculoskeletal system and connective tissue diseases (M00-M99), Aboriginal persons
  • Admissions for genitourinary system diseases (N00-N99), Aboriginal persons
  • Admissions for pregnancy, childbirth and the puerperium (O00-O99), Aboriginal females aged 15 to 44 years
  • Admissions for certain conditions originating in the perinatal period (P00-P96), Aboriginal persons
  • Admissions for injury, poisoning and other external causes (S00-T98), Aboriginal persons

4. Admissions by selected principal diagnosis and age:

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters).

  • Admissions for infectious and parasitic diseases (A00-B99), Aboriginal persons aged 0 to 14 years
  • Admissions for infectious and parasitic diseases (A00-B99), Aboriginal persons aged 15 years and over
  • Admissions for respiratory system diseases (J00-J99), Aboriginal persons aged 0 to 14 years
  • Admissions for respiratory system diseases (J00-J99), Aboriginal persons aged 15 years and over
  • Admissions for digestive system diseases (K00-K93), Aboriginal persons aged 0 to 14 years
  • Admissions for digestive system diseases (K00-K93), Aboriginal persons aged 15 years and over
  • Admissions for injury, poisoning and other external causes (S00-T98), Aboriginal persons aged 0 to 14 years
  • Admissions for injury, poisoning and other external causes (S00-T98), Aboriginal persons aged 15 years and over
5. Same-day admissions for renal dialysis:
  • Same-day admissions for dialysis for kidney disease, Aboriginal persons
6. Admissions for potentially preventable conditions (Vaccine-preventable, Acute and Chronic conditions):
  • Admissions for potentially preventable conditions, Aboriginal persons
7. Admissions for potentially preventable conditions by age (Vaccine-preventable, Acute and Chronic conditions)
  • Admissions for potentially preventable conditions, Aboriginal persons aged 0 to 14 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 15 to 24 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 25 to 44 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 45 to 64 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 65 years and over
  • Admissions for potentially preventable conditions, Aboriginal persons aged 15 years and over
8. Admissions for potentially preventable diagnosis – Acute conditions:
  • Admissions for acute cellulitis, Aboriginal persons
  • Admissions for acute convulsions and epilepsy, Aboriginal persons
  • Admissions for acute dental conditions, Aboriginal persons
  • Admissions for acute ear, nose and throat infections, Aboriginal persons
  • Admissions for acute urinary tract infections, including pyelonephritis, Aboriginal persons
  • Admissions for total acute conditions, Aboriginal persons
9. Admissions for potentially preventable diagnosis – Chronic conditions:
  • Admissions for Chronic Obstructive Pulmonary Disease (COPD), Aboriginal persons
  • Admissions for chronic diabetes complications, Aboriginal persons
  • Admissions for total chronic conditions, Aboriginal persons

Confidentiality of data

Counts of less than five admissions have been suppressed.

Where data are published by age, and either the age groups 0 to 14 years or 15 years and over has been confidentialised, the alternate age group has also been confidentialised for the same area, as their publication would allow identification of the confidentialised age group.

 

Numerator:  Admissions for the above categories

 

Denominator:  Total Aboriginal population

 

Detail of analysis:  Indirectly age-standardised rate per 100,000 (respective population); and/or indirectly age-standardised ratio, based on the Australian standard population (2011).

 

Source:  Compiled by PHIDU using data from the Australian Institute of Health and Welfare, supplied on behalf of State and Territory health departments for 2012/13 to 2014/15; and the estimated resident population (non-ABS) in Indigenous Areas and for Australia in 2011, developed by Prometheus Information Pty Ltd, under a contract with the Australian Government Department of Health.

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