Potentially preventable hospitalisations

Introduction

A subset of hospitalisations are considered potentially preventable and are collectively known as selected potentially preventable hospitalisations (PPHs). Under the National Healthcare Agreement, PPHs are defined as hospitalisations from conditions that could have been prevented through the provision of appropriate individualised preventative health interventions and early disease management, usually delivered in a primary health care and community-based care settings.¹ They are used as measures of system performance in Australia and internationally.²

Potentially preventable hospitalisations are identified from diagnoses recorded in hospital admission data. There are three broad categories: chronic, acute, and vaccine-preventable, consisting of 22 specific health conditions.

Potentially preventable hospitalisations by category

In 2020–21, Queensland residents had 167,675 potentially preventable hospitalisations (PPH) episodes of care in Queensland hospitals.³ These were 5.9% of all hospitalisations.

• The Queensland PPH rate was higher than the national rate and ranked 7th of the jurisdictions.⁴
• Of the three broad categories, acute conditions had the highest standardised rate (16.3 per 1,000 persons), followed by chronic conditions (12.7 per 1,000 persons) (Figure 1).

Figure 1: Selected potentially preventable hospitalisations by category for Queensland residents, 2020–21

Age groups

PPHs vary by age. For example, older people are more likely to have chronic conditions that can lead to hospitalisations, while children are more likely to be hospitalised for acute conditions.

In 2020–21:

• Adults 85 years and older had the highest PPH rate (192.6 per 1,000 persons), with the majority for chronic conditions such as chronic obstructive pulmonary disease (COPD).

A few conditions, such as dental and asthma, had higher rates for children (Figure 2 and Supplemental Figure S1 under Additional information).

Figure 2: Selected potentially preventable hospitalisations in Queensland by category and age, 2020–21

Remoteness and socioeconomic differences

Because PPHs are considered a proxy measure of healthcare availability outside of hospital settings, regional variations may indicate inequitable primary healthcare access and variations in modifiable risk factors.^5,6 Disparities represent an opportunity to improve the health of many Queenslanders.

In 2020–21:

• The standardised rate for total PPHs in remote and very remote areas was double that in major cities and this was evident for each PPH category (Figure 3). Total PPHs were 27.5 per 1,000 persons in major cities compared to 55.7 per 1,000 persons in remote or very remote areas.
• Similar disparities occurred by socioeconomic status—the standardised rate for total PPHs in the most socioeconomically disadvantaged areas was 86.7% higher than in the most advantaged areas (40.6 compared to 21.7 per 1,000 persons, respectively).

Figure 3: Selected potentially preventable hospitalisations by remoteness and socioeconomic status for Queensland residents, 2020–21

Potentially preventable hospitalisations by specific condition

The leading PPH condition in 2020–21 was urinary tract infections, including pyelonephritis, followed by dental conditions and cellulitis, which are acute PPHs.

The conditions with the highest standardised rate differed by sex:

• males—cellulitis, followed by dental conditions and diabetes complications
• females—urinary tract infections, dental conditions and iron deficiency anaemia (Figure 4).

Some effects of COVID-19 public health measures and changes in hospitalisation admission practices were evident in 2020–21. For example, hospitalisations for pneumonia (non-vaccine and vaccine preventable) decreased whereas hospitalisation for dental conditions increased (Supplemental Figure S1 under Additional information).

Figure 4: Selected potentially preventable hospitalisations by specific conditions for Queensland residents, 2020–21

Trends

While standardised rates for PPHs steadily increased from 2010–11 to 2017–18, recent declines were largely driven by decreases for chronic conditions such as angina, asthma, and COPD. PPHs for acute conditions, however, have increased with some variability due to COVID-19.

Vaccine preventable PPHs saw a large decline in 2020–21 due in large part to reduced flu-related hospitalisations from COVID-19 public safety measures (Figure 5 and Supplemental Figure S1 under Additional information).

Figure 5: Trends in selected potentially preventable hospitalisations by sex for Queensland residents

Additional information

Data and statistics

The figure below provides more detailed information for PPHs.

Supplemental Figure S1: Trends in selected potentially preventable hospitalisations in Queensland

Section technical notes

Where presented, ratios were calculated using higher precision estimates than those that are displayed within the report.

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 in a reporting period.

Separations for 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.

For definition on selected potentially preventable hospitalisations, refer to coding standards in METEOR on the Australian Institute of Health website.

Unless otherwise stated, age-standardised rates were calculated by standardising to 2001 Australian standard population.

References

1. Australian Institute of Health and Welfare,. 2021. National Healthcare Agreement: PI 18–Selected potentially preventable hospitalisations, 2022. Accessed: 20 September 2022.
2. Falster M. & Jorm L. 2017. A guide to the potentially preventable hospitalisations indicator in Australia.
3. Queensland Health. 2023. Queensland Hospital Admitted Patient Data Collection (QHAPDC). Accessed: 12 November 2022.
4. Australian Government Productivity Commission. 2022. Report on Government Services 2022. Accessed: 24 October 2022.
5. Australian Institute of Health and Welfare. 2019. Potentially preventable hospitalisations in Australia by age groups and small geographic areas, 2017–18. Accessed: 14 September 2022.
6. Australian Institute of Health and Welfare,. 2020. Disparities in potentially preventable hospitalisations across Australia, 2012-13 to 2017-18. Accessed: 20 September 2022.