Diagnosis

The principal diagnosis recorded for a hospitalisation is ‘the diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care’ (AIHW 2015b; ACCD 2015). Additional diagnoses are those ‘conditions or complaints either coexisting with the principal diagnosis or arising during the episode of admitted patient care’. One or more additional diagnoses can be assigned to the care episode (AIHW 2018; ACCD 2015).

About half of all palliative care-related hospitalisations recorded a principal diagnosis of cancer in 2016–17 (46.7%). Of these, a principal diagnosis of secondary site cancer (that is, a malignant tumour originating from a cancer elsewhere in the body) was assigned to about 1 in 4 (23.5%).

Of the almost 1.1 million cancer-related hospitalisations recorded in 2016–17, 36,133 (3.4%) were palliative care-related. Nearly one-third (30.7%) of all hospitalisations related to a principal diagnosis of pancreatic cancer were palliative care-related, followed by lung cancer (27.4%) and brain cancer  (20.8%).

For diseases with a principal diagnosis other than cancer, the most frequently reported principal diagnoses were stroke and sepsis  (4.2% and 3.7% of palliative care-related hospitalisations, respectively). About 1 in 8 (12.8%) hospitalisations for pneumonitis due to solids and liquids were palliative care-related.

Change over time

Between 2012–13 and 2016–17 the number of palliative care-related hospitalisations increased by 25.6%, from about 61,600 to almost 77,400. The number of all hospitalisations increased by 17.6% over the same period.

The population rate of palliative care-related hospitalisations trended upward from 26.9 to 31.7 per 10,000 population between 2012–13 and 2016–17. Increases in the rate of admitted patient palliative care were evident across all age groups over this period, with some variability in the degree of increase.

Change over time by sector

The number of admitted patient palliative care-related hospitalisations between 2012–13 and 2016–17 increased in both public and private hospitals. The number of public palliative care-related hospitalisations increased by 25.7%, with public hospitalisations for all reasons increasing by 19.1% over the same period.

Numbers of palliative care-related hospitalisations in private hospitals also increased, resulting in a net increase of 25.0% over the same period. This is slightly lower than the increase in all private hospital hospitalisations, which showed 15.3% growth between 2012–13 and 2016–17.

For public hospitals, the rate of palliative care-related hospitalisations increased from 22.7 in 2012–13 to 26.8 per 10,000 in 2016–17. The rate of palliative care hospitalisations in private hospitals also increased over the same period from 4.2 to 4.9 per 10,000 population. For all hospitals, the rate of palliative-related hospitalisations increased from 26.9 to 31.7 per 10,000 over the period.

 
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Figure APC.3 Alternative text - Source data: Admitted patient palliative care and hospital-based facilities tables (538KB XLS)

Change over time by jurisdiction

For public hospitals, the largest average annual increase in palliative care-related hospitalisations between 2012–13 and 2016–17 was for Western Australia (31.5%), 5 times the national average annual increase of 5.9%. The number of palliative care-related hospitalisations in the Northern Territory was essentially flat over the period. The population rate of palliative care-related hospitalisations increased across most states and territories between 2012–13 and 2016–17. For public hospitals, the national population rate increased from 22.7 to 26.8 per 10,000 population over the period.

Among the states and territories where data could be reported for private hospitals, the number of palliative care-related hospitalisations varied over time and across jurisdictions over the period, with a 5.7% average annual increase (25.0% total increase) between 2012–13 and 2016–17. Private hospitals in New South Wales and Western Australia reported average negative growth over the same period (-1.0 and -2.0% respectively), while all other reportable states and territories had an average annual increase in the number of palliative care-related hospitalisations ranging from 3.8% in Victoria to 16.5% in Queensland (Figure APC.4). For private hospitals, the national population rate of palliative care-related hospitalisations increased gradually between 2012–13 (4.2 per 10,000 population) and 2016–17 (4.9).

For those states and territories where data could be reported for all hospital sectors, there was an increase in the number of palliative care-related hospitalisations between 2012–13 and 2016–17 (5.9% average annual increase, 25.6% total increase). For these states and territories, Western Australia reported the highest average annual increase in all hospitals of 13.6. For all hospitals, the national population rate of palliative care-related hospitalisations increased.

 
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Figure APC.4 Alternative text - Source data: Admitted patient palliative care and hospital-based facilities tables (538KB XLS)

Change over time in length of stay

The number of patient days for palliative care-related hospitalisations in admitted patient settings increased by 20.2% between 2012–13 and 2016–17, to a total of 791,740 patient days. The ALOS for palliative care-related hospitalisations trended downwards over the same period (Figure APC.5).

 
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Figure APC.5 Alternative text - Source data: Admitted patient palliative care hospital-based facilities tables (538KB XLS)

Palliative care and deaths in hospital

This section presents data on a subset of palliative care-related hospitalisations—those that ended with the patient’s death. Some admitted patients who died in hospital but were not identified as being ‘palliative care patients’ may also have received some palliation during the hospitalisation that ended with their death. However, as elsewhere in this section, the focus is on those hospitalisations for which palliation was a substantial component of the care provided.

Place of death

In 2016–17, about 160,000 people died in Australia (ABS 2018a). According to data from the NHMD, about 78,500 (49.0%) of these people died as an admitted patient in hospital.

Most states and territories operate hospital-in-the-home (HITH) programs, under which patients are provided with hospital-type care, are categorised as an admitted patient, but receive this care in their home as a substitute for hospital accommodation (AIHW 2012). Admitted patients receiving HITH may have their final hospitalisation in their home; although it is also possible for HITH patients to return to hospital during their final hospitalisation. It should be noted that data quality issues may confound the HITH analysis presented here (see Table APC.16 for further information).

After excluding the small number of HITH patients reported, it is estimated that about 78,300 people died in hospital in 2016–17 which is almost half (49.0%) of all deaths in Australia during that financial year. The proportion of deaths that occurred within the admitted patient setting has ranged from a low of 48.8% to a high of 50.2% over the 5-year period from 2012–13 to 2016–17.

Palliative care patients and death

In 2012–13, 42.1% of admitted patients had been a palliative care patient during the hospitalisation that ended with their death. This proportion has steadily increased such that by 2016–17, 51.6% of people who died as an admitted patient had been a palliative care patient during their final hospitalisation. Although it is difficult to be definitive about the reasons for this increase over time, the growth and ageing of Australia’s population, and the corresponding increase in the prevalence of chronic, progressive and generally incurable illnesses has broadened the type of patient groups requiring palliative care (AIHW 2014; Murtagh et al. 2013).

The number of palliative care patients who died during hospitalisation varied by diagnosis. About half (46.4% or 18,783 patients) of all palliative care patients who died in hospital in 2016-17 had cancer as a principal diagnosis. Of these patients, around 1 in 5 had secondary site cancer (3,587; 19.1%) and 1 in 6 had lung cancer (3,155; 16.8%). Of the non-cancer diseases, 1 in 8 (2,554; 11.8%) patients who died as palliative care patients had a principal diagnosis of a stroke, and 1 in 11 (1,972; 9.1%) sepsis.

About 4 out of 5 admitted patients (79.4%) with a principal diagnosis of cancer who died in 2016–17 were palliative care patients during their final hospital admission. Of the patients with a principal diagnosis of cancer who died during their final hospital admission, high percentages of patients with cancer of the brain (86.5%), breast (84.9%) and pancreas (84.1%) received palliative care. Among admitted patients with a non-cancer principal diagnosis who died, high rates of palliative care occurred where principal diagnoses of renal failure (56.7%), mental and behavioural disorders (55.3%) and stroke (52.2%) were recorded.

Hospital based facilities

Data relating to hospice care units across public hospitals are derived from the National Public Hospital Establishments Database (NPHED). Data for private hospitals, including facilities and specialised services for acute and psychiatric hospitals, are derived from the Private Health Establishments Collection, which is sourced from an annual survey collecting information relating to private hospital activities in Australia (ABS 2018b). Further details on the NPHED database can be found in the data source section.

Hospice units in public hospitals

A hospice care unit is a specialist unit delivering palliative care services and can include both free-standing facilities and wards within a hospital. However, hospices are identified differently in the NPHED across states and territories. Although palliative care services may be delivered in a range of settings, numbers of hospice care units are reported in this section due to their specialised role in palliative care delivery. In addition, the information derived from the NPHED does not include all hospice services in Australia; for example, private health-care providers/hospitals providing hospice care services are not in scope of the NPHED.

In 2016–17, a total of 133 public acute hospitals nationally reported having a hospice care unit. This represents 1 in 5 (19.8%) of the 673 public acute hospitals (excluding public psychiatric hospitals) in Australia. Just under one-third (31.6%) of hospitals with a hospice care unit were located in New South Wales (Figure APC.6). About one-quarter (26.4%) of public acute hospitals in Major cities had a hospice care unit, and 1 in 5 (17.3%) in Regional and Remote (19.1%) area hospitals respectively.

 
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Figure APC.6 Alternative text - Source data: Admitted patient palliative care and hospital-based facilities tables (538KB XLS)

Private acute and psychiatric hospitals

There were 300 private acute and psychiatric hospitals nationally in 2016–17. Of these, 24 (8.0%) had hospice units recorded. The average total number of hospice unit beds available nationally was 281, with an estimated 68,917 patient days and an average length of stay of 11.7 days (ABS 2018b).

 


References

ABS (Australian Bureau of Statistics) 2018a. Deaths, Australia, 2017. ABS cat. no. 3302.0. Canberra: ABS.

ABS 2018b. Private hospitals, Australia 2016–17. ABS Cat. No. 4390.0. Canberra: ABS.

ACCD (Australian Consortium for Classification Development) 2015. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM)—9th edn.—tabular list of diseases, and Alphabetic index of diseases. Adelaide: Independent Hospital Pricing Authority.

AIHW (Australian Institute of Health and Welfare) 2012. National health data dictionary. Version 16. Cat. no. HWI 119. Canberra: AIHW.

AIHW 2014. Australia’s health 2014. Australia’s health series no. 14. Cat. no. AUS 178. Canberra: AIHW.

AIHW 2015a. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW.

AIHW 2015b. National health data dictionary. Version 16.1. National health data dictionary no. 17 Cat. no. HWI 130. Canberra: AIHW.

AIHW 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW.

AIHW 2018. Admitted patient care 2016–17: Australian hospital statistics. Health services series no. 84. Cat. no. HSE 201. Canberra: AIHW.

Murtagh FEM, Bausewein C, Verne J, Groeneveld EI, Kaloki YE & Higginson IJ 2013. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliative Medicine 28(1):49–58 doi: 10.1177/0269216313489367.


Alternative text for Admitted patient care and hospital based facilities

Figure APC.1

Vertical bar chart showing the rate per 10,000 population of palliative care-related hospitalisations by jurisdiction. Public hospitals, NSW 28.7, Vic 30.5, Qld 21.0, WA 17.7, SA 29.5, Tas 42.2, ACT 30.6, NT 30.1, Total 26.8. Private hospitals, NSW 1.4, Vic 4.1, Qld 7.3, WA 9.6, SA 9.0, Total 4.9. Refer to Table APC.3. Back to figure APC.1

Figure APC.2

Vertical bar chart showing the average length of stay for palliative care-related hospitalisations by jurisdiction for public and private hospitals. Average length of stay in public hospitals ranged from 8.1 days in Qld to 10.4 days in Vic. In private hospitals, average length of stay ranged from 8.5 days in SA to 14.6 days in NSW. Refer to Table APC.5. Back to figure APC.2

Figure APC.3

Line graph with two lines showing the rate per 10,000 population of public and private palliative care-related hospitalisations from 2012—13 to 2016—17. The rate for public hospitals trended higher over time from 22.7 in 2012—13 to 26.8 in 2016—17. The rate for private hospitals rose slightly from 2012—13 to 2016—17. Refer to table APC.12. Back to figure APC.3

Figure APC.4

A line graph showing the number of palliative care-related hospitalisations in private hospitals by state and territory from 2012—13 to 2016—17. VIC (2,190 in 2012–132 to 2,544 in 2016–17), Qld (1,946 in 2012–13 to 3,584 in 2016–17) and SA (867 in 2012–13 to 1,546 in 2016–17) generally trended upwards over the period. NSW varied over the period (1,157 in 2012–13 to 1,112 in 2016–17) as did WA (2,683 in 2012–13 to 2,471 in 2016–17). Refer to table APC.13. Back to figure APC.4

Figure APC.5

A combined bar and line graph showing patient days (bars) and average length of stay (line) from 2012–13 to 2016–17. Patient days showed an increasing trend over time from 658,498 in 2012–13 to 791,740 in 2016–176. Average length of stay showed a decreasing trend from 10.7 days in 2012–13 to 10.2 in 2016–17. Refer to table APC.15. Back to figure APC.5

Figure APC.6

Vertical bar chart showing the number of public acute hospitals with hospice care units by jurisdiction. NSW 42, Vic 25, Qld 23, WA 32, SA 8, Tas 1, ACT 1, NT 1. Refer to Table APC.20. Back to figure APC.6