Measure 4.1
- Objective area
- Continuous
- Outcome area
- Coordinated care
- Measure
- Proportion of people with life-limiting illnesses with a potentially preventable hospitalisation in their last 3 months of life.
- Population
- People with life-limiting illnesses who died within the reference year.
- Numerator
- Number of people with life-limiting illnesses with at least one potentially preventable hospitalisation in a public hospital in the last 3 months of life (0-90 days). Namely, an admission within the reference year for any of the following three condition groups: (a) acute conditions (cellulitis, convulsions and epilepsy, dental conditions, ENT infections, gangrene, pelvic inflammatory disease, perforated/bleeding ulcer, pneumonia, UTI); (b) chronic conditions (angina, asthma, bronchiectasis, congestive cardiac failure, COPD, diabetes complications, hypertension, iron deficiency anaemia, nutritional deficiencies, rheumatic heart disease); and (c) vaccine-preventable conditions (pneumonia, influenza, other).
- Denominator
- Number of people with life-limiting illnesses who died within the reference year.
- Computation
- (Numerator ÷ Denominator) x 100
- Disaggregation
- State/Territory, Age, Sex, Socioeconomic area, Remoteness area, Hospitalisation condition group, Cause of death, Length of stay. See Data sources for more information on these items.
- Source
- AIHW National Integrated Health Service Information (NIHSI) linked data asset.
- Definitions
- People with life-limiting illnesses– all people who died in the reference year and had an underlying cause of death amenable to palliative care based on Murtagh et al. (2013) as shown in Table 4.1.2.
Table 4.1.2: Causes of death amenable to palliative care based on Murtagh et al. (2013) Cause of death ICD-10 codes Neoplasm (excludes benign neoplasms) C00-C97 Heart disease I00-I52 Cerebrovascular disease I60-I69 Renal disease N17, N18, N28 Liver disease K70-K77 Respiratory disease J06-J18, J20-J22, J40-J47, J96 Neurodegenerative disease G10, G20, G35, G122, G903, G231 Alzheimer’s disease F01, F03 Dementia G30 Senility R54 HIV/AIDS B20-B24 - Potentially preventable hospitalisation– an admission to hospital for a condition where the hospitalisation could have 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:
Category ICD-10 Additional requirements Acute Cellulitis L02, L03, L04, L08, L88, L98.0, L98.3 As principal diagnosis, AND if the record has: - No procedures whatever OR
- All procedures for the record are within the blocks [1820] to [2016] OR
- The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659].
Convulsions and epilepsy G40, G41, R56 As principal diagnosis. Dental conditions K02 – K06, K08, K09.8, K09.9, K12, K13, K14.0 As principal diagnosis. Ear, nose, and throat infections H66, J02, J03, J06, J31.2 As principal diagnosis. Gangrene R02 In any diagnosis. I70.24, E09.52 As principal diagnosis. Pelvic inflammatory disease N70, N73, N74 As principal diagnosis. Perforated or bleeding ulcer K25.0, K25.1, K25.2, K25.4, K25.5, K25.6, K26.0, K26.1, K26.2, K26.4, K26.5, K26.6, K27.0, K27.1, K27.2, K27.4, K27.5, K27.6, K28.0, K28.1, K28.2, K28.4, K28.5, K28.6
As principal diagnosis. Pneumonia (not vaccine-preventable) J15.3, J15.4, J15.7, J16.0 In any diagnosis. Exclude people under 2 months. Urinary tract infections N10, N11, N12, N13.6, N15.1, N15.9, N28.9, N39.0, N39.9 As principal diagnosis. Chronic Angina I20, I24.0, I24.8, I24.9 As principal diagnosis. Exclude cases according to the list of procedures excluded from the Congestive cardiac failure category. Asthma J45, J46 As principal diagnosis. Exclude children aged less than 4 years. Bronchiectasis J47 As principal diagnosis. J20 As principal diagnosis. Only with additional diagnosis of J47. Congestive cardiac failure
I50, I11.0, J81As principal diagnosis. Exclude cases with the following cardiac procedure codes: Blocks [572], [600]–[606], [608]–[650], [653]–[657], [660]–[664], [666], [669]–[682], [684]–[691], [693], [705]–[707], [717] and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412-00[11], 38721-01[733], 90217-02[734], 90215-02[732]. Chronic obstructive pulmonary disease (COPD) J20 As principal diagnosis. Only with additional diagnoses of J41, J42, J43, J44. J41, J42, J43, J44 As principal diagnosis. Diabetes complications E10.0–E10.9, E11.0–E11.9, E13.0–E13.9, E14.0–E14.9 As principal diagnosis. Hypertension I10, I11.9 As principal diagnosis. Exclude cases with procedure codes according to the list of procedures excluded from the Congestive cardiac failure category. Iron deficiency anaemia D50.1, D50.8, D50.9 As principal diagnosis. Nutritional deficiencies E40, E41, E42, E43, E55.0 As principal diagnosis. Rheumatic heart diseases I00, I01, I02, I05, I06, I07, I08, I09 As principal diagnosis. Vaccine-preventable conditions Other vaccine-preventable conditions including but not limited to measles, rubella, hepatitis B, diptheria, etc. A08.0, A35, A36, A37, A80, B01, B05, B06, B16.1, B16.9, B18.0, B18.1, B26, G00.0 In any diagnosis. Pneumonia and influenza (vaccine-preventable) J10, J11, J13, J14 In any diagnosis. Exclude people under 2 months. - Notes
- There are many factors that can contribute to a lack of individualised preventative health interventions that may lead to a potentially preventable hospitalisation. This can include patient choice, a lack of at-home support, and/or barriers to accessing primary and community care such as geographical remoteness, affordability, and/or opening hours. As such, a certain level of potentially preventable hospitalisations will likely always be present. Reducing their occurrence should be an aim of improving the quality of palliative care in Australia.
- There is currently no complete national data on potentially preventable hospitalisations for people with life-limiting illnesses. The NIHSI linked data asset is the only available national data that identifies inpatient procedures and cause-specific outcomes. However, this data collection does not present a complete picture of health service use, as it excludes hospital data from Western Australia and the Northern Territory, and all private hospitals nationally for this analysis, for the reference period. It omits services received by patients in specialised palliative care units in private hospitals/facilities. See Data sources for more information.
AIHW (Australian Institute of Health and Welfare) (2022) ‘National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations’, 2022, METEOR Metadata Online Registry, accessed 30 January 2024.
AIHW (2020-21) ‘National Integrated Health Services Information’, aihw.gov.au, accessed 22 February 2024.
Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, and Higginson IJ (2013). ‘How many people need palliative care? A study developing and comparing methods for population-based estimates’, Palliative Medicine, doi:10.1177/0269216313489367.