Palliative care services in Australia

This section describes the classification systems referenced in Palliative care services in Australia.

Australian Statistical Geographical Standard for Remoteness Areas

The Australian Statistical Geographical Standard for Remoteness Areas (ASGS) was developed by the Australian Bureau of Statistics (ABS) to collect and disseminate geographically classified statistics (ABS 2011; ABS, 2016).

The ASGS’s remoteness structure categorises geographical areas in Australia into remoteness areas:

• Major cities
• Inner regional
• Outer regional
• Remote
• Very remote.

The ABS website includes detailed information, including the differences between ASGS 2011 and ASGS 2016.

Data on remoteness of geographical location in the NHMD are collected based on patients’ usual residential address and in the NPHED, this is determined by hospital street address. Data on remoteness were defined using the ABS ASGS remoteness structure 2011 (ABS 2011) until 2016-17 and the ASGS remoteness structure 2016 (ABS 2016) from 2017-18 onwards. Further information on the quality of the usual residence of the patient data in the NHMD can be found in Appendix B of Admitted patient care 2018-19.

Index of Relative Socio-economic Disadvantage (IRSD)

The IRSD is 1 of 4 Socio-Economic Indexes for Areas (SEIFA) developed by the ABS (ABS 2018). The IRSD represents the socioeconomic position of Australian communities by measuring aspects of disadvantage, such as low income, low educational attainment, high unemployment, and jobs in relatively unskilled occupations. Areas are then ranked according to their level of disadvantage.

When the IRSD is used in this report, people living in the 20% of areas with the greatest overall level of disadvantage are described as living in the ‘lowest socioeconomic areas’. The 20% of people at the other end of the scale—those living in areas with the least overall level of disadvantage—are described as living in the ‘highest socioeconomic areas’.

It is important to note that the IRSD reflects the overall or average socioeconomic position of the population of an area; it does not show how individuals living in the same area might differ from each other in their socioeconomic position.

Index of Relative Socio-economic Advantage and Disadvantage (IRSAD)

The IRSAD is 1 of 4 Socio-Economic Indexes for Areas (SEIFA) developed by the ABS (ABS 2013) and updated in 2016 (ABS 2018). The IRSAD represents the socioeconomic position of Australian communities by measuring aspect of advantage, such as households with high incomes or people in skilled occupations, and disadvantage, such as households with low incomes and people in unskilled occupations.

The IRSAD provides a measure of socioeconomic status by dividing the Australian population into quintiles based on the area in which they live; the 1st IRSAD quintile represents the 20% of Australian geographical areas experiencing greater socioeconomic disadvantage and a lack of advantage in general, while the 5th IRSAD quintile represents the areas experiencing a relative lack of disadvantage and greater advantage in general (ABS 2013).

Similar to the IRSD mentioned in the previous subsection, it is important to note that the IRSAD reflects the overall or average socioeconomic position of the population of an area; it does not show how individuals living in the same area might differ from each other in their socioeconomic position.

International Statistical Classification of Diseases and Related Health Problems (ICD)

The International Statistical Classification of Diseases and Related Health Problems (ICD), which was developed by the WHO, is the international standard for coding morbidity and mortality statistics. It was designed to promote international comparability in collecting, processing, classifying and presenting these statistics. The ICD is periodically reviewed to reflect changes in clinical and research settings (WHO 2021).

The version currently used in Australia to code causes of death, ICD-10 (WHO 1992), was endorsed in May 1990 and officially came into use in WHO member states from 1994. The 11th revision of the ICD was released in June 2018. Member States will begin reporting health data using ICD-11 in 2022. Further information on the ICD is available from the WHO website

ICD-10-AM

Diagnosis, procedure and external cause hospital data for 2018–19 were reported to the NHMD by all states and territories using the 10th edition of the Australian Modification of ICD-10, referred to as the ICD-10-AM. ICD-10-AM, is based on ICD-10 (NCCH 2013). ICD-10 was modified for the Australian setting by the National Centre for Classification in Health (NCCH) to make it more relevant to Australian clinical practice. Compatibility with ICD-10 at the higher levels (that is, up to 4 character codes) of the classification has been maintained. ICD-10-AM has been used to classify diagnoses in admitted patient hospital records in all Australian states and territories since 1999–00 (AIHW 2000).

The ICD-10-AM disease classification is hierarchical; a small number of summary disease chapters are divided into a large number of more specific disease groupings (represented by 3-character codes). Most of the 3-character disease groupings can be divided into an even larger number of very specific disease categories represented by 4 and 5 character codes (see Table 1 in the Technical notes).

Bettering the Evaluation and Care of Health (BEACH) survey

The BEACH survey of general practice activity was undertaken annually by the Family Medicine Research Centre at the University of Sydney between 1998 and 2016. For each year’s data collection, a random sample of about 1,000 GPs each reported details of 100 consecutive GP encounters of all types on structured encounter forms. Each form collected information about the consultations (for example, date and type of consultation), the patient (for example, date of birth, sex, and reasons for encounter), the problems managed and the management of each problem (for example, treatment provided, prescriptions and referrals). Data on patient risk factors, health status and GP characteristics were also collected.

Additional information on the 2015–16 BEACH survey can be obtained from General practice activity in Australia 2015–16 (Britt et al. 2016). The BEACH survey was run for the last time in 2015–16.

National Aged Care Data Clearinghouse

Data on palliative care in permanent residential aged care (PRAC) are sourced from the AIHW’s National Aged Care Data Clearinghouse that includes data on all recipients of government-funded aged care from 1997 onwards, including prior activity data for those in care in 1997. The holdings mostly relate to government-funded aged care programs operating under the Aged Care Act 1997 and include data on Aged Care Funding Instrument (ACFI) appraisals, which are used to determine Australian Government subsidies for permanent aged care residents. These data have been used for the analyses presented in this report.

The ACFI is a tool used to determine Australian government subsidies for permanent aged care residents, based on a person’s need for care across 3 care domains:

• activities of daily living
• cognition and behaviour
• complex health care (DoH 2016).

ACFI appraisals include:

• relevant mental and behavioural diagnoses outlined in the ACFI user guide Mental and Behavioural disorders Checklist
• up to 3 other medical diagnoses relevant to a resident’s care needs
• 5 questions relating to a resident’s assessed care needs with regard to activities of daily living: nutrition, mobility, personal hygiene, toileting, and continence
• 5 questions relating to a resident’s cognition and behaviour: cognitive skills, wandering, verbal behaviour, physical behaviour, and depression
• 2 questions relating to the need for assistance with the use of medication and ongoing complex health care procedures and activities; with the need for palliative care being covered by these questions (DoH 2016).

Responses to ACFI questions are rated on a scale of A to D and are used to determine the level of care a person needs. While mental health or behavioural diagnoses, along with other medical diagnoses, can be recorded, the ACFI is not designed to be a comprehensive assessment tool.

Note that in this report, only the first listed mental and behavioural diagnoses and first listed other medical diagnosis are included in the analysis.

Note that the ACFI is primarily focused on components of the resident’s care needs that affect the cost of care. Consequently, the capture of information on a person’s care needs, including health conditions and need for assistance with activities of daily living, may be affected by their relevance to the cost of care and the number of available fields on the form.

Funding for palliative care under the ACFI is provided specifically for ‘end of life’ care, which takes place during the last days or week of a care recipient’s life (DoH 2016). Permanent residents who have been appraised as requiring palliative care under the ACFI are included in the ‘palliative care’ group described in this report. It should be noted that if a resident is already on the maximum ACFI Complex Health Care claim, services may not claim for palliative care, as it is not possible to increase the subsidy payable in this situation. For more information about the ACFI, refer to the Department of Health ACFI User Guide website.

The method used to derive the number of permanent aged care residents in this report differs from the approach used in other reporting, such as through the AIHW GEN aged care data website. This commonly presents the number of people in PRAC at 30 June. In the current report, numbers include those who have been a resident at any point during the reporting period. This approach has been taken due to the high proportion of palliative aged care residents who are residents for short periods of time.

Data presented in this report may differ from those published elsewhere due to differences in the preparation and analysis of the source data.

National Health Workforce Data Set (NHWDS)

The Workforce Surveys are administered to all health practitioners registered by the Australian Health Practitioner Regulation Agency (AHPRA) and are included as part of the registration renewal process. The workforce surveys are voluntary. The respective surveys are used to provide nationally consistent workforce estimates. They provide data not readily available from other sources, such as on the type of work done by, and job setting of, health practitioners; the number of hours worked in a clinical or non-clinical role, and in total; and the number of years worked in, and intended to remain in, the health workforce. The survey also provides information on those registered health practitioners who are not undertaking clinical work or who are not employed. The information from the workforce surveys, combined with some National Registration and Accreditation Scheme (NRAS) registration data items, comprises the NHWDS.

Past and present surveys have different collection and estimation methodologies, questionnaire designs and response rates. As a result, care should be taken in comparing historical data from the AIHW Medical Labour Force Surveys prior to 2010 with data from the NHWDS.

Health workforce data are available for public access through the Department of Health’s Health Workforce Data Tool (HWDT) and the numbers in this publication reflect those extracted using the HWDT as at 1 July 2022. In the case of medical specialists, the numbers are those employed whose primary specialty is palliative medicine. For nurses, the numbers are those employed whose principal job area as a nurse is palliative care. There may be differences between the data presented here and that published elsewhere due to different calculation or estimation methodologies or extraction dates. The HWDT uses a randomisation technique to confidentialise small numbers. This can result in differences between the column sum and total and small variations in numbers from one data extract to another.

The palliative care workforce is made up of a broad range of professional groups, each playing a unique role in supporting people with a life limiting illness to receive comprehensive, patient-centred care. It is recognised that general practitioners, other medical specialists, social workers, occupational therapists, physiotherapists, and other allied health professionals form an integral part of the palliative care workforce. However, existing national data sources are not able to accurately capture the extent of palliative care services provided by these health professionals. See the Palliative care workforce section for further details.

Further information regarding the Medical practitioner workforce and Nursing and midwifery workforce surveys is available at Department of Health workforce surveys.

National Hospital Morbidity Database (NHMD)

Data on admitted patient palliative care are sourced from the NHMD. These data pertain to admitted patients in public and private hospitals in Australia. Some of these hospitals have hospices affiliated with them.

The NHMD includes administrative data, demographic information on patients, and clinical information including diagnoses and procedures performed. This annual collection is compiled and maintained by the AIHW, using data supplied by state and territory health authorities. Information from almost all hospitals in Australia is included in the database: from public acute and public psychiatric hospitals, private acute and psychiatric hospitals, and from private free-standing day hospital facilities (Appendix A, AIHW 2020). The latest available data at the date of publication of this report was 2019­­­–20.

Episode-based data

The NHMD is episode based, with the term ‘hospitalisation’ used to refer to an episode of admitted patient care; individual patients may have multiple hospitalisations ending in discharge, transfer or statistical discharge with a change in care type and ultimately death. Each record in the NHMD is based on a single episode of treatment for an admitted patient, with such episodes classified in the ‘Care type’ data item as Acute care, Palliative care, Rehabilitation care, Newborn and other types of care. When a patient receives only one type of care during a hospital stay (such as only Acute care or only Palliative care), the length of stay for that hospitalisation is equal to the total length of time the patient spent in hospital during that stay.

However, where patients receive different types of care during one hospital stay (for example, a person may be admitted for active cancer treatment but then later reclassified as a palliative care patient), the patient may be statistically discharged from the hospital after the first type of care and then statistically readmitted into a second phase of care. Thus, a single patient may have two or more hospitalisations during any one hospital stay. Since each record within the NHMD is based on an episode of care, the hospitalisation count is a count of episodes, not persons. In cases of more than one care type, length of stay refers to the length of the episode of care, not the total duration of the patient’s hospital stay.

Coverage

For each of the years considered in this report, the coverage of the NHMD has been very good. For example, in 2018–19, coverage for the NHMD was high – data from all public hospitals were included. Most private hospitals also provided data, the exceptions being the private free-standing day hospital facilities and two overnight private hospitals in the Australian Capital Territory.  Note that the data for private hospitals in Tasmania, the Australian Capital Territory and the Northern Territory were not published for confidentiality reasons. However, it should be noted that there are no confidentiality concerns about the Tasmanian private hospital data, and that Tasmania would support the release of their private hospital information.

Hospitals may be re-categorised as public or private between or within years (see AIHW 2020 for further information). This should be considered when comparing data by sector over time.

Data on state/territory of hospitalisation should be interpreted with caution because of cross-border flows of patients. This is particularly the case for the Australian Capital Territory. In 2018–19, 17% of hospitalisations in the Australian Capital Territory were for patients who lived in New South Wales.

The AIHW Indigenous identification in hospital separations data: quality report assessed the quality of Indigenous identification in Australian public hospitalisations. The results of this study indicated that data for all jurisdictions should be used in any analyses of Indigenous hospitalisation rates and that the ‘true’ number of Indigenous persons was close to 9% higher than the number indicated in hospital records (AIHW 2013). This should be considered when interpreting the hospital data by Indigenous status. Note, no adjustment has been applied to the Indigenous counts in the hospital data in this report.

Standard admitted patient care data exclusions

As per the standard AIHW practice when analysing admitted patient data in the NHMD, the data presented in this report exclude those records for which the ‘Care type’ data item was reported as newborn (unqualified days only), hospital boarder or organ procurement (posthumous).

Further information

Comprehensive hospital statistics from the NHMD are released by the AIHW on an annual basis in Admitted Patients and further information about the NHMD can be obtained from those publications. Metadata information for the Admitted Patient Care and Local Hospital Networks/Public Hospital Establishments national minimum data sets (NMDSs), that are the basis for the AIHW National Hospital Databases, are published in the AIHW’s online metadata registry – METEOR, and the National Health Data Dictionary.

From 1 July 2013, care types have been reported using revised definitions, with the aim to improve consistency in reporting for the subacute and non-acute care types. Therefore, changes in the care type definitions should be considered when interpreting changes over time.

A complete data quality statement for the NHMD database is available online.

National Public Hospital Establishments Database (NPHED)

The NPHED holds establishment-level data for each public hospital in Australia, including public acute hospitals, psychiatric hospitals, drug and alcohol hospitals, and dental hospitals in all states and territories. The collection covers hospitals within the jurisdiction of the state and territory health authorities only. Hence, public hospitals not administered by the state and territory health authorities (hospitals operated by the Australian Government Department of Health, Department of Defence or correctional authorities, for example, and hospitals located in offshore territories) are not included. The collection does not include data for private hospitals.

For 2019–20, the collection was based on the Local Hospital Networks/Public Hospital Establishments national minimum data set (LHN/PHE NMDS). Information is included on a hospital’s resources, expenditure, average available bed numbers, peer group, and the statistical local area and remoteness area of its location. For more information on the data collection method and other relevant data issues, refer to the 2019–20 NPHED data quality statement.

Palliative Care Outcomes Collaboration (PCOC)

The PCOC is a national program using standardised validated clinical assessment tools to benchmark and measure outcomes in palliative care. The PCOC data set includes the following clinical assessment tools: Palliative Care Phase, Palliative Care Problem Severity Score (PCPSS), Symptom Assessment Scale (SAS), Australia-modified Karnofsky Performance Status (AKPS), and Resource Utilisation Groups – Activities of Daily Living (RUG-ADL) which provide measures of quality and outcomes of care. The PCOC aims to assist services to improve the quality of the palliative care it provides through the analysis and benchmarking of patient outcomes.

Participation in PCOC is voluntary and contribution to the collection is sought from all palliative care service providers in public and private health sectors, across all regions, and across inpatient and community settings. However, not all services participate in PCOC. The data presented in this section therefore describes a subset of all palliative care delivered in Australia. For more information refer to the section on Palliative care outcomes.

Data using Version 1 of the PCOC data set were collected between January 2006 and January 2007. Version 2 of the data set was enacted from July 2007, and Version 3 was implemented in July 2012 (PCOC 2012).

The national figures used in this website reflect all palliative care services that submitted data for the January–December 2021 period. A full list of these services can be found at the Palliative care outcomes collaboration website.

Population data

The majority of the population rates in this publication are crude rates, based on the Australian estimated resident population for the relevant analysis year. Age-standardised rates are calculated for Indigenous data due to the differing age distribution of the Indigenous compared to the general population. The population data were sourced from the ABS and the most up to date estimates available at the time of analysis were used.

To derive estimates of the resident population, the ABS uses the 5-yearly Census of Population and Housing data as follows:

• all respondents to the Census are coded in relation to their state or territory, statistical local area and postcode of usual residence; overseas visitors are excluded,
• an adjustment is made for persons missed in the Census (approximately 2%),
• Australians temporarily overseas on Census night are added to the usual residence Census count.

The resulting numbers provide an estimate of the resident population in the Census year. In the following years, the Census numbers are adjusted by taking into account indicators of population change, such as births, deaths and net migration. More information on the process used to derive population estimates is available from the ABS website .

For the Indigenous rates presented in this website, ‘Series B’ of the projected Indigenous experimental resident population estimates for 30 June 2011, as released by the ABS, was used (ABS 2014).

Mortality data

Submitting cause of death data to the relevant state and territory Registrar of Births, Deaths and Marriages has been compulsory in Australia since the mid-1850s. Since 1906, the Commonwealth Statistician has compiled the information collected by these Registrars and published national death information. The information on deaths from the Registrars is coded nationally by the ABS according to rules set forward in various versions of the International Classification of Diseases (ICD). In the ABS deaths data, information is available in terms of the year in which a person died and the year in which the death was registered.

In the section on admitted patient palliative care, ABS deaths data on the total number of Australian deaths that occurred during the specified financial years are shown (ABS 2017). These mortality data were based on the year of death as this aligns with the information on deaths of admitted patients as reported in the NHMD.

Medicare Benefits Schedule (MBS) data

Services Australia (formerly the Australian Government Department of Human Services) collects data on the activity of all persons making claims through the MBS and provides this information to the Australian Government Department of Health. Information collected includes the type of service provided (MBS item number) and the benefit paid by Services Australia for the service. The item number and benefits paid by Services Australia are based on the Medicare Benefits Schedule Book (DoH 2020). Services that are not included in the MBS are not included in the data.

Table 1: List of all MBS items that have been defined as palliative medicine specialist services

MBS item	MBS group and subgroup	MBS item number
Palliative medicine attendances
Attendance in a hospital or surgery, initial brief video conference	Group A24	3003
Attendance in a hospital or surgery, initial visit	Group A24	3005
Attendance in a hospital or surgery, subsequent visit, minor, after initial attendance	Group A24	3014
Attendance in a hospital or surgery, subsequent visit, other	Group A24	3010
Attendance in a hospital or surgery, video conference	Group A24	3015
Initial home (not at hospital or surgery) visit	Group A24	3018
Subsequent home (not at hospital or surgery) visit	Group A24	3023
Subsequent home (not at hospital or surgery) visit, minor	Group A24	3028
Palliative medicine case conferences
Organise and coordinate a community case conference 15–<30 minutes	Group A24	3032
Organise and coordinate a community case conference 30–<45 minutes	Group A24	3040
Organise and coordinate a community case conference >=45 minutes	Group A24	3044
Participate in a community case conference 15–<30 minutes	Group A24	3051
Participate in a community case conference 30–<45 minutes	Group A24	3055
Participate in a community case conference >=45 minutes	Group A24	3062
Organise and coordinate a discharge case conference 15–<30 minutes	Group A24	3069
Organise and coordinate a discharge case conference 30–<45 minutes	Group A24	3074
Organise and coordinate a discharge case conference >=45 minutes	Group A24	3078
Participate in a discharge case conference 15–<30 minutes	Group A24	3083
Participate in a discharge case conference 30–<45 minutes	Group A24	3088
Participate in a discharge case conference >=45 minutes	Group A24	3093

Note: Refer to the Medicare Benefits Schedule Book (MBS) Jul 2020 edition for full item descriptions (pages 309-313) and further information relating to MBS Palliative care (pages 109-110).

The MBS data presented in this website relate to services provided on a fee-for-service basis for which MBS benefits were paid. The year is determined from the date the service was processed by Services Australia, rather than the date the service was provided. The state or territory is determined according to the postcode of the patient’s mailing address at the last date of service for each patient within the reference period. In some cases, this will not be the same as the postcode of the patient’s residential address. Age and sex are determined from the last date of service within the reference period and attributed to all service claims reported for that individual.

During the COVID-19 pandemic, the Australian Government expanded MBS-subsidised telehealth service to allow Australians to access health services from their home or place of care, and help limit the potential exposure of patients and health practitioners to the virus. This includes 6 new temporary MBS items (91824, 91825, 91826, 91834, 91835 and 91836) which could be used by pain and palliative medicine specialists to provide telehealth services, either by videoconference or by telephone, as a substitution for existing face to face MBS consultation services (Department of Health, 2020). These were not coded separately for palliative care specialists and thus were not able to be included in the data presented here.

Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme data (RPBS)

Previously, the Palliative care services in Australia report has defined types of palliative-care related medicines by categories based on the ATC classification system (see the World Health Organization Collaborating Centre for Drug Statistics methodology for further information on the ATC classification system; WHO 2018).

For the 2022 Palliative care services in Australia report, the method of reporting types of palliative care related prescriptions has been updated, with new categories developed based on the Palliative Care publication of the Australian Therapeutic Guidelines (Therapeutic Guidelines Limited 2021). These categories represent a clinically-meaningful grouping of palliative care symptoms that are often managed with medications listed on the PBS/RPBS Palliative Care Schedule.

The 5 medication groups are:

• Pain relief
• Gastrointestinal symptoms
• Neurological symptoms
• Respiratory symptoms
• Psychological symptoms.

Table 1 lists the medication items from the Palliative Care Schedule with their corresponding medication groups and ATC codes at levels 2, 3 and 5. The items listed are those dispensed from the Palliative Care Schedule during the specific years included in this report (2016–17 to 2020–21).

Note, that the medication types (at the ATC level 2) in previous editions of this report are not directly comparable with the ‘medication group’ presented in this report.

Note that most of these medicines are listed in multiple areas of the Schedule of Pharmaceutical Benefits and are not specific to the Palliative Care Schedule. Data extracted using the ATC codes for the Palliative care services in Australia report for medication groups was filtered by program type (Palliative Care Schedule) to report on all palliative care-related prescriptions.

Table 1. Palliative Care Schedule medicines according to medication group

Medication group	ATC level 2	ATC level 3	ATC level 5	Medication name/s
Pain relief	Antiinflammatory and antirheumatic products	Antiinflammatory and antirheumatic products, non-steroids	M01AB01	Indometacin
			M01AB05	Diclofenac
			M01AE01	Ibuprofen
			M01AE02	Naproxen
	Analgesics	Opioids	N02AA01	Morphine (excluding PBS items 11760Y and 11761B)
			N02AA03	Hydromorphone*
			N02AA05	Oxycodone*
			N02AA55	Oxycodone + Naloxone*
			N02AB03	Fentanyl
			N02AE01	Buprenorphine
			N02AC	Methadone
		Other analgesics and antipyretics	N02BE01	Paracetamol

Gastrointestinal symptoms	Stomatological preparations	Stomatological preparations	A01AD02	Benzydamine
	Drugs for functional gastrointestinal disorders	Propulsives	A03FA01	Metoclopramide
		Belladonna and derivatives, plain	A03BB01	Hyoscine butylbromide (aka butylscopolamine)**
	Drugs for constipation	Drugs for constipation	A06AB02, A06AG02	Bisacodyl
			A06AC53	Rhamnus frangula + sterculia
			A06AD15	Macrogol - 3350
			A06AD15	Macrogol-3350 + sodium chloride + bicarbonate + potassium chloride
			A06AG20	Citric acid + lauryl sulfoacetate sodium + sorbitol
			A06AH01	Methylnaltrexone
Neurological symptoms	Antiepileptics	Antiepileptics	N03AE01	Clonazepam
Respiratory symptoms (Chronic breathlessness)	Analgesics	Opioids	N02AA01	Morphine (PBS items 11760Y and 11761B only)***
Psychological symptoms	Psycholeptics	Antipsychotics	N05AD01	Haloperidol*
		Hypnotics and sedatives	N05CD07	Temazepam
			N05CD02	Nitrazepam
		Anxiolytics	N05BA01	Diazepam
			N05BA04	Oxazepam

* These medicines are included in the report, noting that they were first listed on the PBS Palliative Care Schedule on 1 June 2021 and therefore only include prescriptions for 1 month (to 30 June 2021).

** Hyoscine butylbromide can also be used to manage respiratory secretions.

*** These PBS items are listed on the PBS as Restricted Benefit which can only be prescribed for specific therapeutic uses.

Coverage and scope of data source

PBS/RPBS data do not capture the following:

• Over the counter medicines
• Medicines supplied to public hospital inpatients
• Private prescriptions (that is, if a medicine is not listed under the PBS Schedule for a specific indication, but it has market authorisation by the Therapeutic Goods Administration for sale).

For demographic tables, patient characteristics are determined at a single point in each year, ensuring each person is only counted once in the year.

State and territory are determined according to the patient’s residential postcode as recorded on the Consumer Directory. If the patient’s state or territory is unknown, then the state or territory of the pharmacy supplying the item is reported.

All data are presented by the date of supply, that is, when the prescription was dispensed to the patient.

Relevant changes to the PBS/RBS over time

Reporting of subsidised and under co-payment prescription data

Until 1 April 2012, PBS and RPBS prescription data supplied to the AIHW by the Department of Health excluded prescriptions costing less than the patient co-payment amount (under co-payment). From 1 April 2012, changes to the National Health Act 1953 required pharmacies to supply data for prescriptions that are priced below the patient co-payment level to Services Australia, formerly Department of Human Services (DoH 2011). Under co-payment prescription data were then supplied in PBS/RPBS Palliative Care datasets and were incorporated in the same tables as subsidised prescription data, but were often reported separately. In the Palliative care services in Australia 2022 report (including 2016–17 to 2020–21 PBS/RPBS data), under co-payment and subsidised data are now combined in most tables. An additional table by patient beneficiaries shows the palliative care data by co-payment type in a single table for 2020–21 (Table PBS.4.), rather than including this split in every table.

Changes to restriction levels on the Palliative Care Scheme

On 1 June 2016, as part of the Post-market Review of Authority Required PBS Listings, changes were made to items listed on the Palliative Care Schedule. The restrictions for a number of Palliative Care Schedule items were changed and some medications were added or deleted. The restriction level of certain Palliative Care Schedule items, specifically those in the ‘pain relief’ and ‘gastrointestinal symptoms’ categories, were changed, in many cases from ‘Authority Required (STREAMLINED)’ to ‘Restricted Benefit’, reducing the level of restriction. Certain versions of medications were delisted due to initial and continuing treatment restrictions being simplified and merged under a single item code. Prescriptions written prior to 1 June 2016 for deleted item codes remained valid for a 12-month transition period. Some pain relief items were also added, specifically buprenorphine, resulting in an increase in prescriptions in this category.

Due to these changes, data presented in this report from 2016–17 onwards are not comparable with previous years. These changes particularly affect medications in this report that come under the ‘pain relief’ and ‘gastrointestinal symptoms’ categories.

Identifying palliative care hospitalisations

This section describes the process followed for identifying palliative care hospitalisations in the National Hospital Morbidity Database (NHMD).

The admitted patient palliative care section in this report describes and quantifies admitted patient hospitalisations for which palliative care was provided. Two NHMD data items—‘Care type’ and ‘Diagnosis’— capture information indicating palliative care has been provided to a patient. The AIHW has previously explored how these two data items can be used to identify palliative care hospitalisations in Identifying palliative care separations in admitted patient data: technical paper (AIHW 2011).

Care type data item

A care type is assigned for each admitted patient hospitalisation and describes the overall nature of a clinical service provided to the patient. Only one type of care can be assigned at a time. Where the primary clinical purpose or treatment goal for the patient changes, the change in care type leads to a statistical discharge and a corresponding statistical admission. This means that a person can have multiple hospitalisations recorded for a single stay in hospital.

Prior to 1 July 2013, the Palliative care care type was defined as:

‘care in which the clinical intent or treatment goal is primarily quality of life for a patient with an active, progressive disease with little or no prospect of cure. It is usually evidenced by an interdisciplinary assessment and/or management of the physical, psychological, emotional and spiritual needs of the patient; and a grief and bereavement support service for the patient and their carers/family’.

It includes care provided:

• in a palliative care unit
• in a designated palliative care program; or
• under the principal clinical management of a palliative care physician or, in the opinion of the treating doctor, when the principal clinical intent of care is palliation.

From 1 July 2013, the Palliative care care type was defined as:

‘care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness. The patient will have complex physical, psychosocial and/or spiritual needs’.

Palliative care is always:

• delivered under the management of or informed by a clinician with specialised expertise in palliative care, and
• evidenced by an individualised multidisciplinary assessment and management plan, which is documented in the patient's medical record, that covers the physical, psychological, emotional, social and spiritual needs of the patient and negotiated goals.’

Changes in the care type definitions for Palliative care should be considered when interpreting changes over time. The impact of these changes is likely to be minimal given the data included in this report is from 1 July 2014 onwards.

Coding palliative care as a diagnosis

In addition to the information on the provision of palliative care collected via the care type data item, information on palliative care is also recorded in the NHMD under the diagnosis data items. In Australian hospitals, a principal diagnosis is assigned during each hospitalisation. One or more additional diagnoses may also be assigned. The principal diagnosis is ‘the diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of admitted patient care’ (Appendix B, AIHW 2020; ACCD 2016). An additional diagnosis is ‘a condition or complaint that either co-exists with the principal diagnosis or arises during the episode of care’. Such diagnoses provide information on the conditions that are significant in terms of treatment required, investigations needed and resources used during the episode of care (Appendix B, AIHW 2020; ACCD 2016).

The classification used nationally to assign diagnosis codes is the ICD-10-AM (see Classifications). The specific ICD-10-AM edition used has been updated across the 5-year timespan, with the ninth edition used for 2016–17 data, the tenth edition used for 2017–18 and 2018–19 data and the eleventh edition used for 2019–20 data. Further details about each edition, including the differences between editions, can be found here. One of the codes in the classification—Z51.5—is Palliative care. While diagnosis codes usually describe a condition such as a disease, injury or poisoning, they can also be used in certain instances to indicate the specific care or service provided for a current condition or other reasons for hospitalisation (AIHW 2020). This is the case when Palliative care during a hospitalisation is recorded using a diagnosis code.

Starting with the 9th edition of the ICD-10-AM, a specific ICD-10-AM coding standard—standard ‘2116’—was applied to the recording of Palliative care as a diagnosis (ACCD 2015). The classification instruction clarified that Z51.5 Palliative care should only be assigned where there is documented evidence that the patient has been provided with palliative care and that it may be assigned independent of the admitted patient care type. A new standard was created in the 9th edition to highlight ICD-10-AM codes that should never be assigned as a principal diagnosis (i.e. should be assigned as an additional diagnosis only) and this list includes Z51.5 Palliative care (ACCD 2015). This impacts the Admitted Patient Care National Minimum Data Set from 2015–16 onwards. However, if Z51.5 is reported as a principal diagnosis, the hospitalisation is still counted in this reporting.

In 2019–20, there were about 86,900 hospitalisations identified as providing some form of palliative care, regardless of the care type assigned. These hospitalisations are identified by either the assignment of the ICD-10-AM principal or additional diagnosis code of Palliative care (Z51.5), or by the assignment of the Palliative care type (or both).

From 2015–16, there was a notable increase of hospitalisations with an additional diagnosis code of Palliative care, while hospitalisations assigned with a care type of Palliative care appeared to increase in a more stable fashion when compared with previous years. This change coincided with the aforementioned change in the ICD-10-AM coding standard for palliative care that explicitly stated: ‘Palliative care may be assigned independent of the admitted patient care type’. Therefore, the historical data should be interpreted with caution when interpreting changes over time.

There are evident jurisdictional differences in the level of congruence between the coding of care type and diagnosis items for palliative care patients. For all states and territories, there were some episodes that had only a palliative care type or a palliative care diagnosis code (AIHW 2020). For more information on identifying palliative care hospitalisations, refer to Identifying palliative care separations in admitted patient data: technical paper (AIHW 2011).

Reporting palliative care hospitalisations

From 2020 onwards, the statistics presented in Palliative Care Services in Australia distinguish between hospitalisations with a Palliative care care type, and those with only a Palliative care diagnosis (Z51.5). Prior to 2020, only the total of these was reported to show the widest possible view of the palliative care related activity within admitted patient care. However, this made it difficult to identify specialist palliative care, and thus difficult to reconcile data reported in Palliative Care Services in Australia with other palliative care data, such as the Palliative Care Outcomes Collaboration (PCOC) data reported in the Palliative care outcomes section of this report.

Where a diagnosis of Z51.5 is recorded, but not a Palliative care care type, these hospitalisations are described as “Other end-of-life care”. This approach captures hospitalisations for which a component of the care was considered palliative, but the primary clinical purpose was not recorded for the patient to receive palliative care. The use of the term “other end-of-life-care” refers to the broader palliative care definition, and is not limited to end of life care (generally defined as people who are likely to die within the next 12 months). 

At its March 2011 meeting, the Australian Health Ministers Advisory Committee’s (AHMAC) Palliative Care Working Group endorsed the use of both care type and diagnosis information to identify those hospitalisations for which palliative care was a component of the care provided. At its November 2019 meeting, AHMAC’s new Palliative Care and End of Life Care Data Development Working Group endorsed the change to separately report ‘Palliative care’ related hospitalisations and ‘Other end-of-life care’ hospitalisations.

This technical notes section describes data presentation calculation methodologies.

Population rates

Population rates were calculated using the ABS estimated resident population (ERP) at the midpoint of the data range (for example, rates for 2018–19 data were calculated using ERP at 31 December 2018, while rates for the 2019 calendar year data were calculated using ERP at 30 June 2019). Rates for Indigenous status, socio-economic indexes for areas (SEIFA) and remoteness area data were calculated using ERP at 30 June of the relevant year.

Age-specific rates

Age-specific rates provide information on the incidence of a particular event in a specified age group relative to the total number of people ‘at risk’ of that event in the same age group. It is calculated by dividing the number of events occurring in each specified age group by the corresponding population in the same group, and then multiplying the result by a constant (for example, 10,000) to derive the rate.

Where age-specific rates are reported in the Admitted patient palliative care section; they are expressed per 10,000 persons and were based on ABS population estimates as at 31 December 2018, for example.

Crude rates

A crude rate provides information on the number of events (for example, palliative care hospitalisations) relative to the population ‘at risk’ (for example, the entire population) in a specified period. No age adjustments are made when calculating such a rate and crude rates are used throughout this publication. Note that owing to the differences in approaches used to calculate population rates for different analyses, the rates shown throughout this report for Australia (sometimes labelled as the ‘Total’) may differ slightly from one analysis to another.

Average annual rates of change

Average annual rates of change or growth rates have been calculated as geometric rates:

Average rate of change	=	((Pn/Po)(1/n –1)) x 100
where Pn	=	value in the later time period
Po	=	value in the earlier time period
n	=	number of years between the two time periods.

Descriptive analyses

Information presented in Palliative care services in Australia is based on descriptive statistics. When examining results it should be considered that patterns of relationship between variables may be influenced by known and unknown confounding factors. Furthermore, relationships between variables do not necessarily reflect underlying causal links.

Disease-related information

Information on the number of hospitalisations due to a particular disease, including cancer and other specific diseases (see below), is based on the principal diagnosis, such that the number of hospitalisations for which a certain disease was coded as the principal diagnosis is counted. The principal diagnosis is ‘the diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of admitted patient care’ (Appendix B, AIHW 2020a; ACCD 2016).

Information relating to cancer

The ICD-10-AM diagnosis codes used in the Admitted patient care section to identify patients with cancer mirrors the approach used in AIHW’s Cancer in Australia 2019 report (see Appendix E in AIHW 2019). This approach takes into account that, for some cancer-related hospitalisations, the treatment relating to the patient’s cancer (such as chemotherapy or the insertion of a drug delivery device) is recorded as the principal diagnosis, rather than the specific form of cancer the person had, as per ICD-10-AM coding standards (NCCH 2010). Thus, two different criteria are used to identify those hospitalisations with a principal diagnosis of cancer; these are summarised below.

Approach used to identify hospitalisations with a principal diagnosis of cancer

Hospitalisations that met one of the following criteria were considered to have a principal diagnosis of cancer.

1. Those with a principal diagnosis code of C00–C96, D45, D46, D47.1 or D47.3–D47.5 from the ‘Neoplasms’ chapter of ICD-10-AM.
   • Note that some ICD-10-AM ‘D’ codes are included in this list of invasive neoplasms (that is, cancers) since the related diseases—such as polycythaemia vera (D45)—were not considered to be invasive at the time of the publication of ICD-10 (WHO 1992), but were reclassified as invasive with the publication of the ICD classification that dealt specifically with neoplasms (WHO 2000).
2. Those with a principal diagnosis from Chapter 21 of ICD-10-AM (that is, ICD-10-AM ‘Z’ codes) that was directly related to receiving health services or treatment for cancer as follows:
   • Follow-up examination after treatment for malignant neoplasms (Z08)
   • Breast prophylactic surgery for risk-factors related to malignant neoplasms (Z40.00)
   • Ovary prophylactic surgery for risk-factors related to malignant neoplasms (Z40.01)
   • Radiotherapy session (Z51.0)
   • Pharmacotherapy session for neoplasm (Z51.1)
   • Convalescence following radiotherapy (Z54.1)
   • Convalescence following chemotherapy (Z54.2)

Source: AIHW 2019.

Information relating to other specific diseases

Some diagnoses for palliative care patients are shown at a specific disease level. The best way to group ICD-10-AM codes to identify some diseases (such as heart failure, stroke and chronic obstructive pulmonary disease) is not always straightforward, as different approaches are used in the literature. From 2020, groupings similar to those used in AIHW’s reporting on leading causes of death (AIHW 2020b) have been used, with some variations. A full list is shown in Table 1 below.

Table 1: Diagnosis code groups used to identify specific diseases

Diagnosis codes ICD-10-AM)	Disease description
A00–A09	Intestinal infectious diseases
A15–A19	Tuberculosis
A20, A44, A75–A79, A82–A84, A85.2, A90–A96, A98.0, A98.1, A98.2, A98.8, B50–B57	Vector-borne diseases and rabies
A21–A28	Certain zoonotic bacterial diseases excl. plague
A30–A49 excl. A33–A37, A39, A40–A41, A44	Other bacterial diseases excl. vaccine-preventable diseases, meningitis, septicaemia
A33–A37, A80, B01, B05, B06, B15, B16, B17.0, B18.0, B18.1, B18.9, B19, B26	Vaccine-preventable diseases
A39, G00–G03	Meningitis
A40–A41	Septicaemia
A50–A64	Infections with predominantly sexual mode of transmission
A65–A69	Other spirochaetal diseases
A70–A74	Other diseases caused by chlamydia
A80–A89 excl. A80, A82–A84, A85.2	Viral infections of the central nervous system excl. vaccine-preventable diseases, vector-borne diseases and rabies
A98.3, A98.4, A98.5, A99	Unspecified and selected other viral haemorrhagic fevers
B00–B09 excl. B01, B05, B06	Viral infections with skin and mucous membrane lesions excl. vaccine-preventable diseases
B15–B19 excl. B15, B16, B17.0, B18.0, B18.1, B18.9, B19	Viral hepatitis excl. vaccine-preventable diseases
B20–B24	Human immunodeficiency virus (HIV) disease
B25–B34 excl. B26	Other viral diseases excl. mumps
B35–B49	Mycoses
B50–B64 excl. B50–B57	Protozoal diseases excl. vector-borne diseases
B65–B83	Helminthiases
B85–B89	Pediculosis, acariasis and other infestations
B90–B94	Sequelae of infectious and parasitic diseases
B95–B98	Bacterial, viral and other infectious agents
B99	Other infectious diseases
C00–C14	Malignant neoplasms of lip, oral cavity and pharynx
C15	Oesophageal cancer
C16	Stomach cancer
C17	Malignant neoplasm of small intestine
C18–C20, C26.0	Colorectal cancer
C21	Anal cancer
C22	Liver cancer
C23, C24	Gallbladder cancer
C25	Pancreatic cancer
C26, C39, C76–C80 excl. C26.0	Cancer of unknown or ill-defined primary site
C30, C31, C35–C38	Selected malignant neoplasms of respiratory and intrathoracic organs
C32	Laryngeal cancer
C33, C34	Lung cancer
C40–C41	Malignant neoplasms of bone and articular cartilage
C43	Melanoma of the skin
C44	Other malignant neoplasms of skin
C45–C49	Malignant neoplasms of mesothelial and soft tissue
C50	Breast cancer
C51, C52, C57, C58	Malignant neoplasms of vulva, vagina, other female genital organs, placenta
C53–C55	Uterine cancer
C56	Ovarian cancer
C60, C62, C63	Malignant neoplasms of penis, testis, other male genital organs
C61	Prostate cancer
C64	Kidney cancer
C65, C66, C68	Malignant neoplasms of renal pelvis, bladder, other urinary organs
C67	Bladder cancer
C69, C70, C72	Malignant neoplasms of eye, adnexa, meninges, spinal cord, other parts of the central nervous system
C71	Brain cancer
C73–C75	Malignant neoplasms of thyroid and other endocrine glands
C81–C86, C96	Lymphomas
C88, C90	Malignant immunoproliferative diseases, multiple myeloma and malignant plasma cell neoplasms
C91–C95	Leukaemia
C97	Malignant neoplasms of independent (primary) multiple sites
D00–D48	Benign neoplasms, in situ and uncertain behaviour
D50–D53, E40–E64	Malnutrition and nutritional anaemias
D55–D59	Haemolytic anaemias
D60–D64	Aplastic and other anaemias
D65–D69	Coagulation defects, purpura and other haemorrhagic conditions
D70–D77	Other diseases of blood and blood-forming organs
D80–D89	Certain disorders involving the immune mechanism
E00–E07	Disorders of thyroid gland
E09	Impaired glucose regulation
E10–E14	Diabetes
E15, E16	Other disorders of glucose regulation and pancreatic internal secretion
E20–E35	Disorders of other endocrine glands
E65–E68	Obesity and other hyperalimentation
E70–E89 excl. E86, E87	Selected metabolic disorders excl. dehydration
E86–E87	Disorders of fluid, electrolyte and acid-based balance (dehydration)
F01, F03, G30	Dementia and Alzheimer disease
F04–F09	Organic mental disorders excl. dementia
F10–F19	Mental and behavioural disorders due to psychoactive substance use
F20–F29	Schizophrenia, schizotypal and delusional disorders
F30–F39	Mood (affective) disorders
F40–F48	Neurotic, stress-related and somatoform disorders
F50–F59	Behavioural syndromes associated with physiological disturbances and physical factors
F60–F69	Disorders of adult personality and behaviour
F70–F79	Mental retardation
F80–F89	Disorders of psychological development
F90–F98	Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99	Unspecified mental disorder
G04–G09	Inflammatory diseases of the central nervous system excl. meningitis
G10, G11, G13	Huntington disease and hereditary ataxia
G12	Spinal muscular atrophy and related syndromes
G14	Postpolio syndrome
G20	Parkinson disease
G21–G26	Extrapyramidal and movement disorders excl. Parkinson disease
G31–G32	Other degenerative diseases of nervous system excl. Alzheimer disease
G35–G37	Demyelinating diseases of the central nervous system
G40, G41	Epilepsy and status epilepticus
G42–G47	Episodic and paroxysmal disorders excl. epilepsy
G50–G59	Nerve, nerve root and plexus disorders
G60–G64	Polyneuropathies and other disorders of the peripheral nervous system
G70–G73	Diseases of myoneural junction and muscle
G80–G83	Cerebral palsy and other paralytic syndromes
G90–G99	Other disorders of the nervous system
H00–H59	Diseases of the eye and adnexa
H60–H95	Diseases of the ear and mastoid process
I00–I02	Acute rheumatic fever
I05–I09	Chronic rheumatic heart disease
I10–I15	Hypertensive disease
I20–I25	Coronary heart disease
I26–I28	Pulmonary heart disease and diseases of pulmonary circulation
I30–I33, I39–I41, I43–I45, I52	Selected other forms of heart disease
I34–I38	Non-rheumatic valve disorders
I42	Cardiomyopathy
I46	Cardiac arrest
I47–I49	Cardiac arrhythmias
I50–I51	Heart failure and complications and ill-defined heart disease
I60–I69	Cerebrovascular disease
I70	Atherosclerosis
I71	Aortic aneurysm and dissection
I72–I79	Diseases of arteries, arterioles and capillaries excl. atherosclerosis, aortic aneurysm and dissection
I80–I89	Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified
I95–I98	Other and unspecified disorders of the circulatory system
J00–J06, J20–J22	Acute respiratory diseases excl. influenza and pneumonia
J09–J18	Influenza and pneumonia
J30–J39	Other diseases of upper respiratory tract
J40–J44	Chronic obstructive pulmonary disease (COPD)
J45–J46	Asthma
J47	Bronchiectasis
J60–J70	Lung diseases due to external agents
J80–J84	Pulmonary oedema and other interstitial pulmonary diseases
J85–J86	Suppurative and necrotic conditions of lower respiratory tract
J90–J94	Other diseases of pleura
J95–J99 excl. J96	Other diseases of the respiratory system
J96	Chronic respiratory failure
K00–K14	Diseases of oral cavity, salivary glands and jaws
K20–K31	Diseases of oesophagus, stomach and duodenum
K35–K46, K56	Appendicitis, hernia and intestinal obstruction
K50–K52	Non-infective enteritis and colitis
K55, K57–K64	Other diseases of intestines excl. paralytic ileus and intestinal obstruction without hernia
K65–K67	Diseases of peritoneum
K70–K76	Liver disease
K80–K87	Disorders of gallbladder, biliary tract and pancreas
K90–K93	Other diseases of the digestive system
L00–L08	Infections of the skin and subcutaneous tissue
L10–L14	Bullous disorders
L20–L30	Dermatitis and eczema
L40–L45	Papulosquamous disorders
L50–L54	Urticaria and erythema
L55–L59	Radiation-related disorders of the skin and subcutaneous tissue
L60–L75	Disorders of skin appendages
L80–L99	Other disorders of the skin and subcutaneous tissue
M00–M99	Diseases of the musculoskeletal system and connective tissue
N00–N08	Glomerular disease
N10–N16	Renal tubulo-interstitial disease
N17–N19	Kidney failure
N20–N23	Urolithiasis
N25–N29	Other kidney or ureter disorders
N30–N39	Other urinary disorders
N40–N51	Diseases of male genital organs
N60–N64	Disorders of breast
N70–N77	Inflammatory diseases of female pelvic organs
N80–N98	Non-inflammatory disorders of female genital tract
N99	Other disorders of genitourinary tract
O00–O99	Pregnancy, childbirth and the puerperium
P00–P96, Q00–Q99	Certain conditions originating in the perinatal period, congenital malformations, deformations and chromosomal abnormalities
R00–R94, R96–R99	Other ill-defined causes
R95	Sudden infant death syndrome (SIDS)
S00–S99	Injuries to specific parts of the body
T00–T98	Injuries to multiple body regions, crushing, asphyxiation, poisoning by drugs, other
V01–V89	Land transport accidents
V90–V94	Water transport accidents
V95–V97	Air and space transport accidents
V98–V99	Other and unspecified transport accidents
W00–W19	Accidental falls
W20–W49 excl. W32–W34	Exposure to inanimate mechanical forces excl. firearms
W32–W34	Non-intentional firearm discharge
W50–W64	Exposure to animate mechanical forces
W65–W74	Accidental drowning and submersion
W75–W84	Accidental threats to breathing
W85–W99	Exposure to electric current, radiation and extreme ambient air temperature and pressure
X00–X09	Exposure to smoke, fire and flames
X10–X19	Contact with heat and hot substances
X20–X29	Contact with venomous animals and plants
X30–X39	Exposure to forces of nature
X40–X49	Accidental poisoning
X50–X57	Overexertion, travel and privation
X58	Exposure to other specified factors
X59	Exposure to unspecified factor
X60–X84	Suicide
X85–Y09	Assault
Y10–Y34	Event of undetermined intent
Y35–Y36	Legal intervention and operations of war
Y40–Y59	Drugs, medicaments and biological substances causing adverse effects in therapeutic use
Y60–Y69	Misadventures to patients during surgical and medical care
Y70–Y82	Medical devices associated with misadventures in diagnostic and therapeutic use
Y83–Y84	Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure
Y85–Y89	Sequelae of external causes of morbidity and mortality
Y90–Y98	Supplementary factors related to causes of morbidity and mortality classified elsewhere
Z00–Z99	Factors influencing health status and contact with health services

Patient day statistics

Patient day statistics can be used to provide information on hospital activity that, unlike hospitalisation statistics, accounts for differences in length of stay. As the NHMD contains records for patients ceasing hospitalisation during a specific reporting period (such as 1 July 2018 to 30 June 2019), this means that all patients who ceased hospitalisation during the reporting period are included, regardless of whether or not they were admitted during that period. Thus, not all patient days reported will have occurred during the reporting period. However, it is expected that, in general, patient days for patients who ceased hospitalisation in 2018–19, but who were admitted before 1 July 2018, will be generally counterbalanced by the patient days for patients still in hospital on 30 June 2019 who will cease hospitalisation in future reporting periods.

Quality of Indigenous status data

The AIHW Indigenous identification in hospital separations data: quality report (AIHW 2013) reported on the quality of Indigenous identification in Australian public hospital separations data, based on studies of Indigenous identification in public hospitals conducted during 2011 and 2012. A number of important findings were identified. The results of the included studies indicated that data for all jurisdictions should be used in any analyses of Indigenous hospitalisation rates, and that all states and territories are included in national analyses of Indigenous admitted patient care. Additionally, as noted in the Data Sources section - National Hospital Morbidity Database (NHMD), findings of the report indicated that the ‘true’ number of Indigenous persons was close to 9% higher than the number indicated in hospital records. Note, no adjustment has been applied to the Indigenous counts in the hospital data in this publication.