Hospital episodes of care

All cause hospitalisations

In 2020–21,

• There were 2,857,614 admitted patient episodes of care in Queensland acute public and private hospitals by Queensland residents—53.3% were for females.
• The age-standardised rate (ASR or standardised rate) was 507.4 per 1,000 for persons (537.1 for females and 479.5 for males). ¹

Trends

Standardised hospitalisation rates increased by 44.9%—from 350.1 per 1,000 persons in 2002–03 to 507.4 per 1,000 persons (Figure 1).

• Standardised rates increased every year except in 2019–20 when changes in admission practice and other public safety measures occurred in response to the COVID-19 pandemic.
• Rates increased most in older age groups—the age-specific rate for people 65 years and older increased from 946.0 per 1,000 persons in 2002–03 to 1408.3 per 1,000 persons in 2020–21.

Broad causes of hospitalisations

Admitted patient episodes of care are coded using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM).² ICD codes divide diseases and health conditions into similar categories (ICD chapters) based on the type of disease, the body systems affected, or the circumstances that caused the condition. While changes to ICD coding over time affect the interpretability of the results, understanding admission patterns by ICD chapters provides insights into the broad reasons why people are hospitalised.

Based on principal diagnosis, standardised rates for:

• Factors influencing health status and contact with health services, which includes admissions for routine therapy such as dialysis and chemotherapy, are the most common type for males and females (Figure 2). Repeated hospital admissions for routine therapy are often required for chronic conditions which, in part, contributes to increasing admission rates.
• People 65 years and older have the highest age-specific rate for these types of admissions and most admissions included in other ICD chapters. Exceptions include those related to childbirth, congenital abnormalities and mental health conditions.

Trends

Trends in admitted episodes of care are presented below, however, changes in hospital admission practices and diagnoses coding rules over time mean that results should be viewed with caution.^3–7

Changes in standardised rates for admitted episodes of care include:

• Factors influencing health status and contact with health services increased by 44.0% from 2002–03 to 2020–21, with standardised rates increasing from 80.1 to 115.4 per 1,000 persons.
• Similarly, Symptoms, signs and abnormal findings increased more than two-fold from 19.9 to 44.9 per 1,000 persons.
• Mental and behavioural disorders increased steadily from 2007–08 across all age groups except children.
• Diseases of respiratory system decreased between 2018–2019 and 2020–21. Changes in hospital admission practice during the COVID-19 pandemic and lower numbers of influenza and other respiratory infections were key factors.

Remoteness and socioeconomic differences

Differences in standardised hospitalisation rates between geographic areas are complex and are impacted by multiple factors such as:

• differences in underlying patterns of disease and injury
• the number of hospitalisations needed to treat health conditions
• the availability and accessibility of healthcare locally.

Results should be interpreted as broad patterns that may indicate a need for further analysis. Such analysis, such as adjusting for repeated admissions for a single person, would provide more specific insights for specific conditions.

In 2020–21, people living in remote and very remote areas of Queensland had higher hospitalisation rates. Standardised rates in remote and very remote areas were 620.1 per 1,000 persons in 2020–21 but ranged from 493.3 to 516.2 in major cities and regional areas (Figure 4).

Differences in standardised rates for specific ICD chapters include:

• Factors influencing health status and contact with health services—199.1 per 1,000 persons in remote and very remote areas compared to 111.4 per 1,000 persons in major cities
• Injury poisoning and other external causes—58.7 per 1,000 persons in remote and very remote areas compared to 36.1 per 1,000 persons in major cities.

Conversely, the rate for Mental and behavioural disorders was nearly twice as high in the major cities area compared to remote and very remote areas. Under the ICD coding system, Mental and behavioural disorders includes dementia and Alzheimer’s disease which should be considered in interpreting these results.

Similar patterns were seen between areas with different socioeconomic profiles. Queenslanders living in the most disadvantage areas had the highest standardised hospitalisation rates for Factors influencing health status and contact with health services and Injury poisoning and other external causes while rates for Mental and behavioural disorders were highest among those people living in the most advantaged areas (Figure 4).

Additional information

Data and statistics

More information about Queensland hospitalisations is available from the Queensland Health performance and Statistical Services Branch.

National health statistics are available on the AIHW Admitted patients and Australia’s hospital at glance websites.

Section technical notes

• Where presented, ratios were calculated using higher precision estimates than those that are displayed within the report.
• The ICD coding system is maintained by the World Health Organization and provides internationally comparable mortality and morbidity statistics over time and between regions. In Australia, the ICD-10 was adapted for the Australian context from the WHO ICD system. The ICD-10-AM is now maintained by the Independent Health and Aged Care Pricing Authority (IHACPA).⁵
• Multiple factors may cause a person’s hospital admission. The principal diagnosis is the one deemed chiefly responsible for the admission.
• Data reported in this section were sourced from the Queensland Hospital Admitted Patient Data Collection (QHAPDC). Individual records in the QHAPDC are episode based, meaning that multiple episodes from the same person will be counted multiple times in a reporting period.
• Separations from interstate residents, public psychiatric hospitals and those flagged as unqualified newborns, organ donors or boarders are excluded. Records from 47 previously declared hospitals are excluded.
• Unless otherwise stated, age-standardised rates were calculated by standardising to 2001 Australian standard population.

References

1. Queensland Health. 2023. Queensland Hospital Admitted Patient Data Collection (QHAPDC). Accessed: 12 November 2022.
2. Independent Health and Aged Care Pricing Authority. 2022. ICD-10-AM/ACHI/ACS. Accessed: 4 November 2022.
3. Queensland Health. 2011. Impact of changes in diabetes coding on Queensland hospital principal diagnosis morbidity data. Accessed: 11 November 2022.
4. Queensland Health. 2015. Recent growth in public hospital separations – more than meets the eye?. Accessed: 4 November 2022.
5. Queensland Health. 2018. Impact of changes to coding of rehabilitation episodes of care. Accessed: 4 November 2022.
6. Queensland Health. 2018. Impact of changes to coding palliative care. Accessed: 4 November 2022.
7. Queensland Health. 2018. Rehabilitation episodes of care: Top 10 principal diagnosis codes 2014/2015 to 2016/2017. Accessed: 4 November 2022.