Notes on the data: Aboriginal hospital admissions

Aboriginal admissions by selected principal diagnosis; by selected principal diagnosis and age; and by ambulatory-sensitive hospitalisations by age, 2012/13

 

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 2012–13, Aboriginal and Torres Strait Islander people had about 2.7 times the separation rate than that for other Australians. About 86% of the difference between these rates was due to higher separation rates for Indigenous Australians admitted for same-day maintenance kidney dialysis [1].

References

  1. Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2012-13. Health services series no. 54. (Cat. no. HSE 145.) Canberra: AIHW; 2014.
  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 more technical '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.

Ambulatory-sensitive hospitalisations are admissions that are considered to be potentially preventable. [For further information see Australian Institute of Health and Welfare. Australian hospital statistics 2012-13. Health services series no. 54. (Cat. no. HSE 145.) Canberra: AIHW; 2014.]

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. The impact of these hospital transfers would result in a higher rate of admissions in regional areas compared to the metropolitan areas, as well as for certain conditions which are more likely to result in transfers.

Caution should be used in the interpretation of these data because of jurisdictional differences in data quality [1] as well as under-identification of Aboriginal and Torres Strait Islander people. The AIHW report Indigenous identification in hospital separations data: quality report  (AIHW 2013h) 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 [3]. [For further information see Australian Institute of Health and Welfare. Australian hospital statistics 2012-13. Health services series no. 54. (Cat. no. HSE 145.) Canberra: AIHW; 2014.]

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 Australian Institute of Health and Welfare. Australian hospital statistics 2012-13. Health services series no. 54. (Cat. no. HSE 145.) Canberra: AIHW; 2014.]

Details of data presented

Note that Total hospital admissions include same-day admissions for dialysis for kidney disease.

For Northern Territory Indigenous Areas, the Department of Health of the Northern Territory allow hospitalisation data to be published at the Indigenous Region level only. The figures reported for the Indigenous Areas are the figures for an Indigenous Area’s corresponding Indigenous Region.

Separate data are presented for:

1. Admissions by selected principal diagnosis:

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

  • Total admissions, Aboriginal persons
  • Admissions for mental health related conditions (F00-F99), 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 injury, poisoning and other external causes (S00-T98), Aboriginal persons

2. Admissions by selected principal diagnosis and age:

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

  • Total admissions, Aboriginal persons aged 0 to 14 years
  • Total admissions, Aboriginal persons aged 15 years and over
  • Admissions for mental health related conditions (F00-F99), Aboriginal persons aged 15 years and over
  • Admissions for circulatory system diseases (I00-I99), 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 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
3. Ambulatory-sensitive hospitalisations by age:
  • Total ambulatory-sensitive hospitalisations, Aboriginal persons aged 0 to 14 years
  • Total ambulatory-sensitive hospitalisations, Aboriginal persons aged 15 years and over
  • Total ambulatory-sensitive hospitalisations, Aboriginal persons at all ages

Confidentiality of data

Counts of less than ten 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, or Aboriginal population aged 0 to 14 years /Aboriginal population aged 15 years and over, where appropriate

 

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

 

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; and the estimated resident population (non-ABS), average of 30 June 2012 and 2013, compiled by PHIDU based on data developed by Prometheus Information Pty Ltd, under a contract with the Australian Government Department of Health.

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