This report reviews the available research evidence on the impact of initiatives to reduce potentially avoidable hospitalisations.
The Australian Institute of Health and Welfare (AIHW) described potentially avoidable hospitalisations (PAHs) as “admissions to hospital that could have potentially been prevented through the provision of appropriate non-hospital health services”. The AIHW classify PAHs into three main types: Vaccine-preventable, chronic and acute conditions. In 2009-10, PAHs related to chronic conditions were the most common, due mainly to the high rates of hospitalisations for diabetes complications (24% of all PAHs). Moderately high rates of PAHs were also reported for chronic obstructive pulmonary disease (COPD), dehydration and gastroenteritis, and dental conditions (9-10% of all PAHs).
Several independent groups of researchers have shown that poor access to primary health care is strongly related to higher rates of PAHs. In Australia, data on PAHs are collected routinely by the AIHW6 and used as an indicator of primary health care accessibility and effectiveness.
However, it is important to note some limitations and caveats pertaining to PAHs data and interpreting analyses:
- Accuracy of PAHs estimates. In an extensive review of the literature, the Agency for Healthcare Research and Quality (AHRQ) stated that it is often difficult to accurately determine the extent to which PAHs are avoidable, particularly in chronic conditions where there is inevitable physical deterioration.
- Variations in coding for PAHs. The statistical reliability of data on PAHs varies due to differences in the way data are coded across hospitals.
- Reliability of PAHs as an indicator of primary health care access. The AHRQ suggest that PAHs should be analysed and interpreted as a set, rather than in specific disease groups as statistical analyses becomes less reliable where there are small numbers of people with a particular condition.
- Level of access to primary health care. Weinberger et al. cautioned that higher rates of hospitalisation are not necessarily due to poor access to primary care, but may reflect better access. That is, hospitalisation may occur as a result of better detection of impairments in the primary health care setting.
- Role of other factors. Beyond access to primary health care, socioeconomic disadvantage, rurality, comorbidities and certain immutable factors, such as age, gender and ethnicity are also associated with high rates of PAHs.
Reducing the rates of PAHs in Australia is a key objective in several important Australian Government health care agreements: Australia’s National Health Performance Framework, the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and the Council of Australian Governments (COAG) National Healthcare Agreement. To address this objective, a number of initiatives have been implemented in States and Territories and nationally, with varying degrees of success.
This report reviews the available research evidence on the impact of initiatives to reduce PAHs. While many health reform policies and initiatives have been implemented, only those that have been evaluated for their effectiveness in reducing PAHs have been included in this report.
Authored by Rachel Katterl, Olga Anikeeva, Caryn Butler, Lynsey Brown, Bradley Smith and Petra Bywood.