Potentially preventable hospitalisations (PPH) for this report are defined in accordance with the National Healthcare Agreement (NHA) indicator PI 18-Selected potentially preventable hospitalisations. It has been reported at PHN area and SA3 level through the Performance and Accountability Framework.

The term PPH does not mean that a patient admitted for that condition did not need to be hospitalised at the time of admission. Rather the hospitalisation could have potentially been prevented through the provision of appropriate preventative health interventions and early disease management in primary care and community-based care settings (including by general practitioners, medical specialists, dentists, nurses and allied health professionals). PPH rates are indicators of the effectiveness of non-hospital care. The rate of PPH in a local area may reflect access to primary health care, as well as sociodemographic factors and health behaviours (Falster & Jorm 2017).

There are 22 conditions for which hospitalisation is considered potentially preventable across 3 broad categories:

1. Vaccine-preventable conditions

These are diseases that can be prevented by vaccination. These are grouped as pneumonia and influenza (vaccine-preventable) and other vaccine-preventable conditions. Other vaccine-preventable conditions include:

  • chicken pox (varicella)
  • diphtheria
  • haemophilus meningitis
  • hepatitis B
  • German measles (rubella)
  • measles
  • mumps
  • polio
  • rotavirus
  • tetanus
  • whooping cough (pertussis)

2. Acute conditions

These are conditions that theoretically would not result in hospitalisation if adequate and timely care (usually non-hospital) was received. They include:

  • cellulitis
  • convulsions  and epilepsy
  • dental conditions
  • ear, nose and throat infections
  • eclampsia
  • gangrene
  • pelvic inflammatory disease
  • perforated/bleeding ulcer
  • pneumonia (not vaccine-preventable)
  • urinary tract infections (including kidney infections)

3. Chronic conditions

These are conditions that may be preventable through behaviour modification and lifestyle change, but can also be managed effectively through timely care (usually non-hospital) to prevent deterioration and hospitalisation. They include:

  • angina
  • asthma
  • bronchiectasis
  • chronic obstructive pulmonary disease (COPD)
  • congestive heart failure
  • diabetes complications
  • hypertension
  • iron deficiency anaemia
  • nutritional deficiencies
  • rheumatic heart diseases

Reducing hospitalisations for these conditions might involve vaccination, early diagnosis and treatment, and/or good ongoing management of risk factors and conditions in community settings.

The data are presented for the 31 Primary Health Network (PHN) areas and more than 300 smaller local areas, known as Statistical Areas Level 3 (SA3s). All information relates to where a person lived, not where they went to hospital.

This local-level information can be used as an indicator of patients’ access to primary health care services and the appropriateness or effectiveness of care, as well as preventive health interventions. It is intended to assist local health professionals to develop strategies for change where needed, in the context of their local area. 

How many potentially preventable hospitalisations were there in 2016–17?

There were more than 715,000 hospitalisations in Australia in 2016–17 for the 22 conditions for which hospitalisation is considered potentially preventable. This represented 6% of all hospital admissions to a public or private hospital in Australia that year. Potentially preventable hospitalisations accounted for more than 2.8 million bed days nationally—equivalent to 9% of all public and private hospital bed days.

Nationally, the age-standardised rate of PPH was 2,732 per 100,000 people. Across PHN areas, rates of PPH were almost 3 times as high in some areas compared with others, ranging from 2,032 PPH per 100,000 people in Northern Sydney to 5,777 per 100,000 in the Northern Territory (Figure 1).

Figure 1: Potentially preventable hospitalisations across Primary Health Network areas, age-standardised per 100,000 people, 2016–17

Figure 1: Potentially preventable hospitalisations across Primary Health Network areas, age-standardised per 100,000 people, 2016–17
The horizontal bar chart shows that the age-standardised rate of potentially preventable hospitalisations across primary health networks in 2016–17 ranged from 2,032 per 100,000 people in Northern Sydney to 5,777 per 100,000 people in the Northern Territory. The chart also shows that the corresponding national rate was 2,732 per 100,000 people.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Sources: AIHW analysis of the National Hospital Morbidity Database 2016–17; Australian Bureau of Statistics, Estimated Resident Population.

There was even greater variation across the more than 300 smaller local areas (SA3s). The age-standardised rates of PPH were more than five times as high in some areas compared with others, ranging from 1,540 per 100,000 people in Barwon–West (Vic) to 9,286 hospitalisations per 100,000 in Alice Springs (NT).

Potentially preventable hospitalisation categories

The majority of PPH hospitalisations nationally were for chronic (47%) and acute (46%) conditions, with vaccine-preventable conditions accounting for 8%.

Nationally, the age-standardised rate of PPH for chronic conditions was 1,249 per 100,000 people. Rates of PPH for chronic conditions were more than 3 times as high in some PHN areas compared with others, ranging from 811 per 100,000 people in Northern Sydney to 2,531 per 100,000 in Western Queensland (Figure 2).

The national age-standardised rate of PPH for acute conditions was 1,296 per 100,000 people. Rates of PPH for acute conditions were almost 3 times as high in some PHN areas compared with others—ranging from 958 per 100,000 in Central and Eastern Sydney to 2,656 per 100,000 in Western Queensland (Figure 2).

There was even more variation across PHN areas for PPH for vaccine-preventable conditions, with rates more than 12 times as high in some PHNs. Nationally the rate was 213 per 100,000, with rates lowest in Gippsland (85 per 100,000) and highest in the Northern Territory (1,065 per 100,000).

Figure 2: Potentially preventable hospitalisations across Primary Health Network areas by category, age-standardised per 100,000 people, 2016–17

Figure 2: Potentially preventable hospitalisations across Primary Health Network areas by category, age-standardised per 100,000 people, 2016–17 The horizontal stacked bar chart shows the age-standardised rates of potentially preventable hospitalisations across primary health networks in 2016–17 by category of potentially preventable hospitalisation. These categories are chronic, acute and vaccine-preventable. 
The chart shows that for all PHNs, the age-standardised rates of potentially preventable hospitalisations for chronic and acute conditions were similar, and rates for vaccine-preventable conditions were much less.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Sources: AIHW analysis of the National Hospital Morbidity Database 2016–17; Australian Bureau of Statistics, Estimated Resident Population.

References

Falster M & Jorm L 2017. A guide to the potentially preventable hospitalisations indicator in Australia. Centre for Big Data Research in Health, University of New South Wales in consultation with Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare: Sydney.