A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations
1
Cluster for Resilience and Wellbeing, Appleton and Manna Institutes, Central Queensland University, Brisbane, QLD 4701, Australia
2
Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, VIC 3550, Australia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2024, 21(9), 1192; https://doi.org/10.3390/ijerph21091192
Submission received: 2 July 2024
/
Revised: 26 August 2024
/
Accepted: 3 September 2024
/
Published: 9 September 2024
(This article belongs to the Special Issue Advances in Nursing and Medical Education)
Abstract
:Potentially Preventable Hospitalisations (PPH) is a widely used indicator of the effectiveness of non-hospital care. Specified using the International Classification of Diseases (ICD) coding, PPH comprises a suite of health conditions that could have potentially been prevented with appropriate care. The most recent edition of the National Guide to a Preventative Health Assessment for First Nations People documents the health conditions of interest to providers of primary care, many of which are not represented in PPH. Given the National Guide has been developed specifically with First Nations in mind, the aim of this research is twofold. The first aim is to formally posit the question of whether a summative measure of hospitalisations aligned diagnostically to the National Guide has value either as an alternative or complement to PPH in the context of First Nations primary health information. The second aim is to develop and present a prototype ICD-10 data specification for such a measure, referred to as the First Nations primary healthcare (FNPHC) data specification, and examine the age-standardised hospitalisation rates for FNPHC and PPH for correlations and/or differences. Age-standardised hospitalisation rates from 2016–17 to 2019–20 using both classifications were examined to assess the usefulness and relevance of summative measures of hospitalisations for informing primary care. Rates of FNPHC for principal diagnoses were between 1.5 and 2.5 times higher than those of PPH and approximately between 6 and 12 times higher for additional diagnoses. There was a strong correlation with PPH when rates were compared across all observations: jurisdictions with higher rates of PPH tended to have higher rates of hospitalisations according to the custom specification. Findings support its application as a summary measure for First Nations primary care providers. Given the policy landscape in Australia that aims to close the gap, it is imperative that measures of primary health take advantage of the concepts and application of First Nations data sovereignty and governance. The validity and cultural appropriateness of the First Nations primary health data specification needs to be further researched.
1. Introduction
In 2007, the Australian Commonwealth, state, territory and local governments made a commitment to work together to close the gap in First Nations disadvantage [1]. This led to the National First Nations Reform Agreement, a significant step toward more co-ordinated action [2]. There are 17 national socio-economic targets across areas that have impacts on life outcomes for First Nations Australians in health and wellbeing, education, employment, justice, safety, housing, land and waters, languages and digital inclusion. Five of these targets relate to health and well-being, with a key priority being to close the health and life-expectancy gap between First Nations and other Australians within a generation [1]. Achieving equality in life expectancy and closing the gap in life expectancy within a generation is not on track to be met by 2031: First Nations people still have a lower life expectancy than other Australians [2,3].
The primary care sector plays an integral and determining role in achieving these national targets [4,5,6,7,8,9,10]; however, the data and information available on the health and well-being of Australian people are predominantly sourced from outside the primary care sector. Since 2006, the Australian Institute of Health and Welfare (AIHW) has generated Health Performance Framework (HPF) reports that provide a range of information pertaining to First Nations health and well-being outcomes, as well as factors influencing the performance of the health system [7,8,9]. Data from hospital admissions and national health surveys feature heavily in this framework. A recent article published in this journal questioned the utility of the HPF to inform healthcare reform [11]. Hospitalisation for ambulatory care-sensitive conditions, also called ‘potentially preventable’ or ‘avoidable’ hospitalisations, has been used extensively as an indicator of the accessibility and overall effectiveness of primary healthcare [12,13,14]. Specified using the International Classification of Diseases, 10th Edition, Australian Modification (ICD-10-AM), Potentially Preventable Hospitalisations (PPH) are organised into 22 diagnosis groups across 3 categories of vaccine-preventable conditions, chronic conditions and acute conditions [15].
Latest data from Australia suggest that, in 2022–2023, there were 548,000 PPHs in public hospitals and 178,000 in private hospitals. These included 273,000 hospitalisations for chronic conditions (excluding diabetes), 58,300 hospitalisations for diabetes complications, and 55,500 hospitalisations for vaccine-preventable conditions. The likelihood of a person having a PPH can vary according to their age, sex, where they live, their level of socioeconomic disadvantage and First Nations status [8]. First Nations people account for 3.3% of the Australian population [16] but were hospitalised for potentially preventable conditions at three times the rate of non-First Nation Australians between July 2019 and June 2021 (based on age-standardised rates) [9]. Overall, between 2013–2014 and 2020–2021, the gap between First Nations people and First Nation Australians increased from a rate difference of 40 PPH per 1000 population (in 2013–2014) to 46 PPH per 1000 population (in 2020–2021). At a national level, the rate of PPH for First Nations people was higher for those living in remote rather than non-remote areas. The rate among First Nations people was highest for those living in remote areas (97 PPH per 1000 population), followed by very remote areas (91 PPH per 1000 population). The rate was lowest for those in major cities and inner regional areas (both 40 PPH per 1000 population), followed by outer regional areas (57 per 1000 population) [9].
The majority of PPHs involve conditions that could have been identified and treated earlier by either primary healthcare or public health interventions and, thus, prevented, or at least limited, the necessity for hospital care. Consequently, the indicator is commonly used by governments to provide an evidence-based foundation for targeted interventions designed to control costs and improve primary healthcare effectiveness. A review of the Health Needs Assessments published by Australia’s 31 primary health networks found that PPH was included as an indicator of primary health needs in all assessments that were publicly accessible (n = 29). Approximately two-thirds (n = 19) referenced PPH specifically in the context of First Nations primary health needs [3,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32].
The most recent edition of the National Guide to a Preventative Health Assessment for First Nations people documents the health conditions of interest to providers of primary care [33]. It compiles comprehensive, evidence-based advice and guidance on the best practices for providers of primary healthcare across the lifecycle. Developed with the National Aboriginal Community Controlled Health Organisation and the Royal Australian College of General Practitioners, the National Guide consists of seventeen chapters, each addressing an important domain of health and wellbeing. Despite the dominant use of PPH in health statistics as a proxy measure of primary care effectiveness, PPH omits many of the health conditions relevant to primary care according to the National Guide (e.g., cancer, chronic kidney disease, conditions of the eyes and ears, STI, mental health, alcohol and drug use, dementia, osteoporosis, lifestyle factors) [33]. Given the National Guide has been developed specifically with First Nations primary health in mind, the aim of this research is twofold. The first aim is to formally posit the question of whether a summative measure of hospitalisations aligned diagnostically to the National Guide has value either as an alternative or complement to PPH in the context of First Nations primary health information. The second aim is to develop and present a prototype ICD-10 data specification for such a measure, referred to as the First Nations primary healthcare (FNPHC) data specification, and examine the age-standardised hospitalisation rates for FNPHC and PPH for correlations and/or differences.
2. Methods
2.1. Approach
The National Guide was reviewed, and health conditions of interest were coded using the ICD-10-AM (referred to interchangeably hereafter with ICD-10 for brevity where needed). Where a condition also existed as a measure in the HPF reporting, the ICD-10 specifications utilised and published by the Australian Institute of Health and Welfare were adopted. For example, Chapter 9 of the National Guide relates to respiratory health with a subsection specifically for asthma. Section 1.04 of the HPF relates to respiratory health, and the ICD-10 specification for asthma utilised in HPF reporting (J45–J46) was adopted for the FNPHC specification also. Conversely, Chapter 5 of the National Guide relates to the health of older persons and has a subsection for falls in people 50 years and older. No such specification exists in the HPF, so the relevant ICD-10 codes W05–W10 were included in this category. Figure 1 summarises this decision process.
ICD-10 codes were organised into sixteen categories: Diabetes, Respiratory health, Circulatory health, Acute rheumatic fever and rheumatic heart disease (ARF/RHD), Chronic kidney disease (CKD), Eyes and ears, Oral health, Sexually transmitted infections (STI) and blood-borne diseases, Cancer, Depression and suicide, Mental disorders, Mental-health related conditions, Alzheimer and dementia, Alcohol and drugs, Older adults and Lifestyle factors. Age-standardised hospitalisation rates from 2016–2017 to 2019–2020 using both classifications were calculated. FNPHC rates were compared descriptively with PPH with respect to correlations and rate ratios. Hospitalisation rates using the FNPHC specification were examined for each diagnosis category, principal or additional diagnoses and regional variation to explore an application of the FNPHC and consider implications for implementation in practice.
2.2. Data
Data were requested from the National Hospital Morbidity Database—a repository of episode-level records from admitted patient data collections in Australian public and private hospitals—using the FNPHC and PPH specifications. Annual counts of admitted patients (identified as First Nations people) were provided for each specified category for financial years 2016–2017 through 2019–2020 by State/Territory and five–year age groups from 0–4 through 65+. Counts were provided for both principal (PDx) and additional (ADx) diagnoses under the FNPHC specification, except for codes designating external causes (X60–X84, X45, Y15, W05–W10, W18–W19, X85–Y09) for which the concept of principal or additional diagnosis does not apply.
Population data for First Nations people were obtained from the Australian Bureau of Statistics via the online data explorer (explore.data.abs.gov.au, accessed on 22 December 2022), using the Series B projection for States and Territories. Population data by calendar year was converted to financial years by taking the average of the population across the two calendar years.
Age-standardised hospitalisation rates (per 1000 population) were calculated using the 2001 Australian population standard for both FNPHC and PPH specifications. For the FNPHC specification, rates for both principal and additional diagnoses for all categories and the sum total were calculated and compared. External cause codes were included in the relevant category totals (Table 1) for both (principal/additional) calculations. External cause diagnoses were included in the relevant category totals for both principal and additional diagnosis rate calculations.
2.3. Ethics
Ethics approval was obtained from the Human Research Ethics Committee at Central Queensland University (Application Number 22739).
3. Results
Table 1 shows the FNPHC specification and its alignment with the National Guide and HPF. There was good alignment between these categories and the chapters of the National Guide, particularly where the relevant health conditions are presented as discrete chapters, for example, Respiratory health (Chapter 9). Conversely, some conditions were relevant to more than one chapter. Diabetes, for example, is important to antenatal care (Chapter 2) and diabetes prevention and early detection (Chapter 12). The category of Lifestyle factors contained several items that were important to more than one chapter of the National Guide.
Extensions to the chapters were made in developing the FNPHC specification. Chapter 17 of the National Guide addresses mental health but specifies only prevention of depression and prevention of suicide as sub–chapters. Together, these comprise the Depression and suicide category in the FNPHC specification to align with the National Guide. The categories Mental disorders and Mental health-related conditions were adopted directly from the HPF and included in the FNPHC specification (excluding those codes already used for depression and dementia in their respective categories) to provide greater utility in measuring mental health more broadly. Chapter 16 relates to family abuse and violence, for which no ICD-10 specifications could be established. External cause codes for assault (X85–Y09) were included in the FNPHC specification under Lifestyle factors to capture this aspect. Implications are considered in the discussion.
3.1. FNPHC Categories
As a total measure, FNPHC hospitalisations with a principal diagnosis at the national level were between 125.5 and 134.7 per 1000 for the period of collected data. Hospitalisations for FNPHC as an additional diagnosis are over four times higher each year—between 561.1 and 597.3 per 1000. Additional diagnoses were more inclusive in all categories except for Respiratory health, Eyes and ears and Oral health, where rates of principal diagnoses were between 1.3 and 1.7 times higher than those of additional diagnoses. National rates by year are presented for all FNPHC categories in Table 2.
3.2. Comparison with Potentially Preventable Hospitalisations
Age-standardised FNPHC rates were compared with those of PPH. FNPHC and PPH specifications are not independent. ICD-10 codes common to both specifications are shown in Supplementary Table S1. Little variability of rates across years was observed in all jurisdictions for both PPH and FNPHC measures (see Figure 2). Rates of FNPHC as principal diagnoses were between 1.5 and 2.5 times higher than those of PPH and approximately between 6 and 12 times higher for additional diagnoses (Figure 2 and Figure 3). Rates for additional diagnoses increased differentially for Western Australia compared to other jurisdictions owing to an increase in additional diagnoses in the categories Diabetes and CKD, peaking in 2018–2019. Rates and ratios for all years by jurisdiction are included in Supplementary Table S2.
Spearman’s rank correlation coefficients between measures were not significant except for South Australia, which had a negative correlation (years with higher rates of PPH had lower rates of FNPHC; ρ = −1, p < 0.001), and for the Australian Capital Territory, which had a positive correlation (years with higher rates of PPH also had higher rates of FNPHC; ρ = 1, p < 0.001) for principal diagnoses only (Table 3). Correlating all observations by jurisdiction-year showed a positive association with PPH in both principal and additional diagnoses: jurisdictions with higher rates of PPH were statistically likely to also have higher rates of FNPHC (ρ = 0.95–0.96, p < 0.001; see Figure 3).
3.3. Principal and Additional Diagnoses
As a total measure, FNPHC rates for additional diagnoses were higher than rates for principal diagnoses. This was also true of most individual categories, except for Oral health, Eyes and ears and Respiratory health, which were more likely to be reported as principal diagnoses. STI and blood-borne diseases were almost exclusively reported in additional diagnoses in Tasmania and the ACT and accounted for less than one per thousand hospitalisations in other jurisdictions. Figure 4 shows the rate ratios of additional to principal diagnoses for each category and financial year. All rates by jurisdiction, year and category are provided in Supplementary Table S3.
Rates based on principal diagnoses were correlated with those based on additional diagnoses for all FNPHC categories by State/Territory and financial year. There was a generally high-ranking correlation between rates based on principal and additional diagnoses for each category. That is, jurisdictions and financial years with high rates of principal diagnoses also tended to have higher rates of additional diagnoses relative to other jurisdictions and years. Values of Spearman’s correlation were high, between 0.7 and 0.9, except for Mental health-related conditions (ρ = 0.44), and were significant at the 0.01 level. However, weak or non-existent correlations were observed for Oral health, Cancer, Depression and suicide, Older adults and Lifestyle factors, and none of which were statistically significant. Table 4 shows the rank correlation coefficients for each category.
4. Discussion
This study developed a prototype ICD-10 specification to reflect the health conditions of interest to First Nations primary healthcare as advised by the National Guide and compared rates of hospitalisation with those of the traditional PPH data. As a total summative measure, the FNPHC classification contains more diagnostic categories than PPH, and this is reflected in the higher rates of hospitalisation observed under the former classification.
There was no clear evidence of a correlation between the two measures; however, it must be noted that hospitalisation rates nationally changed by less than 5 per 1000 for PPH and less than 10 per 1000 for FNPHC across the period observed. There was a strong correlation between the measures for jurisdiction-years, with States/Territories that had higher rates of PPH also tended to have higher rates of FNPHC hospitalisations. The specifications are not mutually exclusive in terms of the diagnoses included, which contributes to the statistical association; however, many of the conditions documented in the National Guide are not represented in the PPH specification. It is, therefore, also possible that both specifications reflect the underlying area’s propensity for hospitalisations or health status in a general way. Analysis of data for smaller geographical regions and/or linked data for individuals would help elucidate these relationships.
Year-to-year variability was more likely to be observed when considering additional diagnoses as the inclusion criteria rather than principal diagnoses alone. With respect to individual disease/condition categories, higher rates were typically observed in additional diagnoses; however, this was not the case for Oral health, Eyes and ears and Respiratory health. Further consultation is required with First Nations health workers and health practitioners regarding the appropriateness and usefulness of principal or additional diagnoses. Further, as this work is a desktop and document analysis, clinical validation and further refinements to the specification would strengthen the validity of the measure, such as those benefiting the PPH specification: diagnosis-specific inclusion/exclusion criteria regarding principal or additional diagnoses, age and hospital procedures. For example, heart failure (I50) is counted only as a principal diagnosis and excludes admissions for heart surgeries; acute bronchitis (J20) is counted only as a principal diagnosis and if the admission has an additional diagnosis of bronchiectasis (J47). Similar refinements to the FNPHC specification warrant consideration.
Of particular importance is the fact that cancer is not included in the PPH specification but has a dedicated chapter in the National Guide. This highlights the fundamental disconnect between the concept of avoidable hospitalisations and the prevalence of health conditions that are of interest to primary care that motivated the current study. The FNPHC specification has high face validity owing to its direct relationship to the National Guide; however, the value of a broad, summative measure of hospitalisations to inform First Nations primary care—be it PPH or FNPHC—should also be questioned and further tested. As with any indicator, they can add value when used as outcome variables in conjunction with other explanatory or input variables, such as those reflecting service activity in the case of primary care, rather than providing a numerical value in isolation. Examining correlations between FNPHC and other health system measures is a topic for future research.
5. Conclusions
This research has developed a First Nations primary health data (FNPHC) specification and compared it with the traditional specification derived using PPH. Preliminary findings support its application as a summary measure for First Nations primary care providers to monitor hospitalisations for health conditions specified in the National Guide. Given the policy landscape in Australia that aims to close the gap, it is imperative that measures of primary health take advantage of the concepts and application of First Nations data sovereignty and governance. The validity and cultural appropriateness of the First Nations primary health data specification needs to be further researched.
Supplementary Materials
The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph21091192/s1, Table S1. Overlap between PPH and FNPHC specifications; Table S2. Aged-standardised rates and rate ratios for Potentially Preventable Hospitalisations; Table S3. Age-standardised rates for all categories of FNPHC.
Author Contributions
As lead author, B.P. was responsible for data extraction and analysis. All authors (B.P., C.M.D. and S.J.B.) contributed to conceptual thinking and manuscript preparation. All authors have read and agreed to the published version of the manuscript.
Funding
This research was partially funded by Allen and Clarke as part of a larger project funded by the Australian Government Department of Health.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Human Research Ethics Committee at Central Queensland University (Application Number 22739, approval December 2020).
Informed Consent Statement
Not applicable, as the study is based on routinely collected data.
Data Availability Statement
All data used in the manuscript are available upon request by contacting the lead author.
Conflicts of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.
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Figure 1.
Process for ICD-10-AM specification of conditions addressed in the National Guide.
Figure 2.
Jurisdictional comparison of PPH and FNPHC hospitalisation rates.
Figure 3.
Rate ratios and correlation between all observations of PPH and FNPHC hospitalisations. The distribution of rate ratios across State/Territory for FNPHC:PPH is shown; a vertical line denotes ratio = 1.
Figure 3.
Rate ratios and correlation between all observations of PPH and FNPHC hospitalisations. The distribution of rate ratios across State/Territory for FNPHC:PPH is shown; a vertical line denotes ratio = 1.
Figure 4.
Rate ratios of additional diagnoses and principal diagnoses for FNPHC categories. The second panel shows ratios on a base-10 logarithmic scale to highlight categories where principal diagnoses exceed additional diagnoses.
Figure 4.
Rate ratios of additional diagnoses and principal diagnoses for FNPHC categories. The second panel shows ratios on a base-10 logarithmic scale to highlight categories where principal diagnoses exceed additional diagnoses.
Table 1.
ICD-10-AM specification for conditions of interest to First Nations primary healthcare (FNPHC).
Table 1.
ICD-10-AM specification for conditions of interest to First Nations primary healthcare (FNPHC).
| Category | Sub-Category | ICD-10 Code(s) | ICD-10 Description | National Guide Alignment | Health Performance Framework Alignment |
|---|---|---|---|---|---|
| Diabetes | Diabetes | E10–E14 | Diabetes mellitus | Chapter 2: Antenatal care-Diabetes, Chapter 12: Type 2 diabetes prevention and early detection-Diabetes | 1.09 Diabetes, 1.23 Leading causes of mortality, 3.05 Chronic disease management, 3.18 Care planning for chronic diseases |
| Respiratory health | Asthma | J45 | Asthma | Chapter 9: Respiratory health-Asthma | 1.04 Respiratory health |
| J46 | Status asthmaticus | ||||
| COPD | J41–J44 | Simple and mucopurulent chronic bronchitis; Unspecified chronic bronchitis; Emphysema; Other chronic obstructive pulmonary disease | Chapter 9: Respiratory health-Chronic obstructive pulmonary disease | 1.04 Respiratory health, 3.02 Immunisation | |
| Bronchiectasis | J47 | Bronchiectasis | Chapter 9: Respiratory health-Bronchiectasis and chronic suppurative lung disease | 1.04 Respiratory health, 3.02 Immunisation | |
| Influenza | J09–J11 | Influenza | Chapter 9: Respiratory health-Influenza prevention | 1.04 Respiratory health, 3.02 Immunisation | |
| Pneumonia | J12–J18 | Pneumonia | Chapter 9: Respiratory health-Pneumococcal disease prevention | 1.04 Respiratory health, 3.02 Immunisation | |
| Circulatory health | Other circulatory disease | I60–I69 | Cerebrovascular diseases | Chapter 11: Cardiovascular disease prevention-CVD | 1.23 Leading causes of mortality, 1.05 Circulatory disease |
| I70–I79 | Diseases of arteries, arterioles and capillaries | ||||
| I80–I89 | Diseases of veins, lymphatic vessels and lymph nodes not elsewhere classified | ||||
| I95–I99 | Other and unspecified disorders of the circulatory system | ||||
| Heart disease | I20–I25 | Ischaemic heart diseases | Chapter 11: Cardiovascular disease prevention-CVD | 1.23 Leading causes of mortality, 1.05 Circulatory disease | |
| I26–I28 | Pulmonary heart disease and diseases of pulmonary circulation | ||||
| I30–I52 | Other forms of heart disease | ||||
| Hypertension | I10–I15 | Hypertensive diseases | Chapter 11: Cardiovascular disease prevention-CVD | 1.23 Leading causes of mortality, 1.05 Circulatory disease, 1.07 High blood pressure, | |
| ARF/RHD | ARF | I00–I02 | Acute rheumatic fever | Chapter 10: Acute rheumatic fever and rheumatic heart disease | 1.06 Acute rheumatic fever and rheumatic heart disease |
| RHD | I05–I09 | Chronic rheumatic heart diseases | Chapter 10: Acute rheumatic fever and rheumatic heart disease | 1.06 Acute rheumatic fever and rheumatic heart disease | |
| CKD | CKD | N18 | Chronic kidney disease | Chapter 13: Chronic kidney disease prevention and management-Kidney disease | 1.10 Kidney disease, 1.23 Leading causes of mortality |
| Eyes and Ears | Trachoma and trichiasis | A71 | Trachoma | Chapter 6: Eye health-Trachoma and trichiasis | 1.16 Eye health |
| H02.0 | Entropion and trichiasis of eyelid | ||||
| Eyes | H00–H59 | Diseases of the eye and adnexa | Chapter 6: Eye health-Visual acuity | 1.16 Eye health | |
| Ears | H60–H95 | Diseases of the ear and mastoid process | Chapter 7: Hearing loss-Hearing | 1.15 Ear health | |
| Oral health | Oral health | K02 | Dental caries | Chapter 8: Oral and dental health-Oral and dental | 1.11 Oral health |
| K05 | Gingivitis and periodontal diseases | ||||
| K08.1 | Complete loss of teeth | ||||
| STI and blood-borne diseases | Hepatitis C | B17.1 | Acute hepatitis C | Chapter 14: Sexual health and blood-borne viruses-Blood-borne viruses, Chapter 2: Antenatal care-Genitourinary and blood-borne viral infections | 3.02 Immunisation |
| B18.2 | Chronic viral hepatitis C | ||||
| Hepatitis | B17.1 | Acute hepatitis C | Chapter 14: Sexual health and blood-borne viruses-Blood-borne viruses, Chapter 2: Antenatal care-Genitourinary and blood-borne viral infections | 3.02 Immunisation | |
| B18.2 | Chronic viral hepatitis C | ||||
| B16 | Acute hepatitis B | Chapter 14: Sexual health and blood-borne viruses-Blood-borne viruses | 3.02 Immunisation | ||
| B17.0 | Acute delta-(super)infection of hepatitis B carrier | ||||
| B18.0 | Chronic viral hepatitis B with delta-agent | ||||
| B18.1 | Chronic viral hepatitis B without delta-agent | ||||
| Sexual health | A50–A64 | Infections with a predominantly sexual mode of transmission | Chapter 14: Sexual health and blood-borne viruses-Sexually transmitted infections, Chapter 2: Antenatal care-Genitourinary and blood-borne viral infections | 1.12 HIV, AIDS, hepatitis and sexually transmissible infections | |
| B20–B24 | Human immunodeficiency virus [HIV] disease | ||||
| Cancer | Cancer | C50 | Malignant neoplasm of breast | Chapter 15: Prevention and early detection of cancer-Prevention and early detection of breast cancer | 1.08 Cancer, 1.23 Leading causes of mortality |
| C53 | Malignant neoplasm of cervix uteri | Chapter 15: Prevention and early detection of cancer-Prevention and early detection of cervical cancer | |||
| C18 | Malignant neoplasm of colon | Chapter 15: Prevention and early detection of cancer-Prevention and early detection of colorectal (bowel) cancer | |||
| C19 | Malignant neoplasm of rectosigmoid junction | ||||
| C20 | Malignant neoplasm of rectum | ||||
| C21.8 | Malignant neoplasm: Overlapping lesion of rectum, anus and anal canal | ||||
| C22 | Malignant neoplasm of liver and intrahepatic bile ducts | Chapter 15: Prevention and early detection of cancer-Prevention and early detection of primary liver (hepatocellular) cancer | |||
| C34 | Malignant neoplasm of bronchus and lung | Chapter 15: Prevention and early detection of cancer-Prevention of lung cancer | |||
| C61 | Malignant neoplasm of prostate | Chapter 15: Prevention and early detection of cancer-Early detection of prostate cancer | |||
| Depression and suicide | Depression | F32 | Depressive episode | Chapter 17: Mental health-Prevention of depression | 3.10 Access to mental health services |
| F33 | Recurrent depressive disorder | ||||
| F34.1 | Dysthymia | ||||
| Suicide and Intentional Self-harm | X60–X84 | Intentional self-harm | Chapter 17: Mental health-Prevention of suicide | 3.10 Access to mental health services, 1.23 Leading causes of mortality | |
| Mental disorders | Mental disorders (not due to substance abuse) | F04–F09 | Organic, including symptomatic mental disorders (excluding dementia codes F00–F03). | Chapter 17: Mental health-Mental disorders (not specified in guidelines) | 3.10 Access to mental health services |
| F20–F29 | Schizophrenia, schizotypal and delusional disorders | ||||
| F30–F39 | Mood [affective] disorders (excluding depression codes F32, F33, F34.1). | ||||
| 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 | ||||
| Mental-health-related conditions | Mental health-related conditions | G47.0 | Disorders of initiating and maintaining sleep [insomnias] | Chapter 17: Mental health-Mental health-related hospitalisations (not specified in guidelines), Chapter 4: The health of young people-Social emotional wellbeing | 1.18 Social and emotional well-being, 3.10 Access to mental health services |
| G47.1 | Disorders of excessive somnolence [hypersomnias] | ||||
| G47.2 | Disorders of the sleep–wake schedule | ||||
| G47.8 | Other sleep disorders | ||||
| G47.9 | Sleep disorder, unspecified | ||||
| O99.3 | Mental disorders and diseases of the nervous system complicating pregnancy, childbirth and the puerperium | ||||
| R44 | Other symptoms and signs involving general sensations and perceptions | ||||
| R45.0 | Nervousness | ||||
| R45.1 | Restlessness and agitation | ||||
| R45.4 | Irritability and anger | ||||
| R48 | Dyslexia and other symbolic dysfunctions, nec | ||||
| Z00.4 | General psychiatric examination, not elsewhere classified | ||||
| Z03.2 | Observation for suspected mental and behavioural disorders | ||||
| Z04.6 | General psychiatric examination, requested by authority | ||||
| Z09.3 | Follow-up examination after psychotherapy | ||||
| Z13.3 | Special screening examination for mental and behavioural disorders | ||||
| Z50.2 | Alcohol rehabilitation | ||||
| Z50.3 | Drug rehabilitation | ||||
| Z54.3 | Convalescence following psychotherapy | ||||
| Z61.9 | Negative life event in childhood, unspecified | ||||
| Z63.1 | Problems in relationship with parents and in-laws | ||||
| Z63.8 | Other specified problems related to primary support group | ||||
| Z63.9 | Problem related to primary support group, unspecified | ||||
| Z65.8 | Other specified problems related to psychosocial circumstances | ||||
| Z65.9 | Problem related to unspecified psychosocial circumstances | ||||
| Z71.4 | Alcohol abuse counselling and surveillance | ||||
| Z76.0 | Issue of repeat prescription | ||||
| Alzheimer and dementia | Alzheimer | G30 | Alzheimer’s disease | Chapter 17: Mental health–Alzheimer (not specified in guidelines) | 3.10 Access to mental health services, 1.23 Leading causes of mortality |
| Dementia | F00–F03 | Dementia in Alzheimer’s disease; Vascular dementia; Dementia in other diseases classified elsewhere; Unspecified dementia | Chapter 5: The health of older people-Dementia | 3.10 Access to mental health services | |
| Alcohol and drugs | Alcohol | F10 | Mental and behavioural disorders due to use of alcohol | Chapter 1: Lifestyle-Alcohol | 2.16 Risky alcohol consumption, 3.11 Access to alcohol and drug services |
| T51 | Toxic effect of alcohol | ||||
| X45 | Accidental poisoning by and exposure to alcohol | ||||
| Y15 | Poisoning by and exposure to alcohol, undetermined intent | ||||
| Drugs | F11–F16 | Mental and behavioural disorders due to use of opioids; Mental and behavioural disorders due to use of cannabinoids; Mental and behavioural disorders due to use of sedatives or hypnotics; Mental and behavioural disorders due to use of cocaine; Mental and behavioural disorders due to use of other stimulants, including caffeine; Mental and behavioural disorders due to use of hallucinogens | Chapter 4: The health of young people-Illicit drug use | 2.17 Drug and other substance use, including inhalants; 3.11 Access to alcohol and drug services | |
| F18 | Mental and behavioural disorders due to use of volatile solvents | ||||
| F19 | Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances | ||||
| T36 | Poisoning by systemic antibiotics | ||||
| T37 | Poisoning by other systemic anti-infectives and antiparasitics | ||||
| T39 | Poisoning by nonopioid analgesics, antipyretics and antirheumatics | ||||
| T40 | Poisoning by narcotics and psychodysleptics [hallucinogens] | ||||
| T42 | Poisoning by antiepileptic, sedative–hypnotic and anti-Parkinsonism drugs | ||||
| T43 | Poisoning by psychotropic drugs, not elsewhere classified | ||||
| T52 | Toxic effect of organic solvents | ||||
| Older adults (50+) | Falls | W05–W10 | Fall involving wheelchair; Fall involving bed; Fall involving chair; Fall involving other furniture; Fall involving playground equipment; Fall on and from stairs and steps | Chapter 5: The health of older people-Falls | |
| W18–W19 | Other fall on same level; Unspecified fall | ||||
| Osteoporosis | M80–M82 | Osteoporosis with pathological fracture; Osteoporosis without pathological fracture; Osteoporosis in diseases classified elsewhere | Chapter 5: The health of older people-Osteoporosis | ||
| Lifestyle factors | Anaemia | D50–D53 | Nutritional anaemias | Chapter 3: Child health-Anaemia, Chapter 2: Antenatal care-Nutrition and nutritional supplementation | 2.19 Dietary behaviour |
| Obesity | E66 | Obesity | Chapter 1: Lifestyle-Overweight and obesity | 2.22 Overweight and obesity | |
| Assault | X85–Y09 | Assault | Chapter 16: Family abuse and violence-Violence (Assault not specified in guidelines except for FAV) | 2.10 Community safety | |
| Tobacco use | Z72.0 | Tobacco use | Chapter 1: Lifestyle-Smoking, Chapter 2: Antenatal care-Smoking cessation | 2.21 Healthy behaviours during pregnancy, 2.03 Environmental tobacco smoke, 2.15 Tobacco use | |
| Alcohol use | Z72.1 | Alcohol use | Chapter 1: Lifestyle-Alcohol | 2.16 Risky alcohol consumption, 3.11 Access to alcohol and drug services | |
| Drug use | Z72.2 | Drug use | Chapter 4: The health of young people-Illicit drug use | 2.17 Drug and other substance use, including inhalants; 3.11 Access to alcohol and drug services | |
| Physical activity | Z72.3 | Lack of physical exercise | Chapter 1: Lifestyle-Physical activity | 2.18 Physical activity | |
| Diet | Z72.4 | Inappropriate diet and eating habits | Chapter 2: Antenatal care-Nutrition and nutritional supplementation, Chapter 1: Lifestyle-Dietary habits (not chapter-specific) | 2.19 Dietary behaviour, 1.23 Leading causes of mortality, 2.19 Dietary behaviour | |
| Sexual behaviour | Z72.5 | High-risk sexual behaviour | Chapter 14: Sexual health and blood-borne viruses-General prevention advice | 1.12 HIV, AIDS, hepatitis and sexually transmissible infections | |
| Gambling | Z72.6 | Gambling and betting | Chapter 1: Lifestyle-Gambling | ||
| Other lifestyle | Z72.8 | Other problems related to lifestyle | Chapter 1: Lifestyle-Other lifestyle problems (not chapter-specific) | ||
| Lifestyle, unspecified | Z72.9 | Problem related to lifestyle, unspecified | Chapter 1: Lifestyle-Unspecified lifestyle problems (not chapter-specific) |
Table 2.
Age-standardised hospitalisation rates for FNPHC for financial years 2016–2017 through 2019–2020.
Table 2.
Age-standardised hospitalisation rates for FNPHC for financial years 2016–2017 through 2019–2020.
| FY 2016–2017 | FY 2017–2018 | FY 2018–2019 | FY 2019–2020 | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FNPHC Category | PDx | ADx | Any Dx | PDx | ADx | Any Dx | PDx | ADx | Any Dx | PDx | ADx | Any Dx |
| Diabetes | 6.15 | 133.66 | 139.81 | 6.48 | 148.69 | 155.16 | 7.09 | 162.72 | 169.81 | 7.13 | 146.91 | 154.04 |
| Respiratory health | 26.03 | 20.02 | 46.04 | 27.31 | 21.39 | 48.71 | 28.74 | 22.15 | 50.89 | 26.38 | 20.80 | 47.17 |
| Circulatory health | 30.54 | 71.42 | 101.96 | 29.81 | 73.04 | 102.85 | 30.94 | 73.89 | 104.84 | 30.47 | 61.88 | 92.35 |
| ARF/RHD | 0.82 | 1.79 | 2.61 | 0.81 | 1.68 | 2.48 | 0.84 | 1.69 | 2.54 | 0.72 | 1.44 | 2.15 |
| CKD | 1.73 | 67.56 | 69.29 | 1.80 | 51.78 | 53.58 | 1.73 | 62.49 | 64.21 | 2.01 | 49.05 | 51.06 |
| Eyes and ears | 14.08 | 8.95 | 23.03 | 14.32 | 8.80 | 23.12 | 15.42 | 8.97 | 24.39 | 13.95 | 8.09 | 22.04 |
| Oral health | 1.80 | 1.33 | 3.13 | 1.88 | 1.32 | 3.20 | 2.02 | 1.41 | 3.43 | 1.83 | 1.32 | 3.15 |
| STI and blood-borne diseases | 0.32 | 21.74 | 22.05 | 0.30 | 21.57 | 21.87 | 0.35 | 20.51 | 20.86 | 0.31 | 19.25 | 19.56 |
| Cancer | 4.08 | 10.09 | 14.17 | 4.04 | 10.52 | 14.56 | 4.38 | 11.94 | 16.32 | 4.42 | 12.38 | 16.80 |
| Depression and suicide | 3.31 | 7.30 | 10.61 | 3.26 | 7.03 | 10.29 | 3.59 | 7.21 | 10.80 | 3.63 | 6.81 | 10.44 |
| Mental disorders | 14.59 | 17.76 | 32.36 | 15.31 | 18.97 | 34.28 | 16.09 | 21.01 | 37.10 | 17.80 | 20.31 | 38.12 |
| Mental-health related | 0.71 | 7.92 | 8.63 | 0.80 | 8.40 | 9.20 | 0.87 | 9.65 | 10.52 | 0.79 | 8.61 | 9.40 |
| Alzheimer and dementia | 0.56 | 3.55 | 4.12 | 0.46 | 3.24 | 3.70 | 0.50 | 3.34 | 3.84 | 0.52 | 3.44 | 3.96 |
| Alcohol and drugs | 16.08 | 54.78 | 70.85 | 15.87 | 53.40 | 69.27 | 16.24 | 52.83 | 69.07 | 17.82 | 53.16 | 70.98 |
| Older adults (50+) | 0.09 | 3.85 | 3.94 | 0.14 | 3.97 | 4.11 | 0.13 | 4.01 | 4.14 | 0.16 | 4.13 | 4.28 |
| Lifestyle factors | 4.62 | 129.38 | 134.01 | 5.32 | 130.17 | 135.49 | 5.75 | 133.48 | 139.24 | 5.56 | 132.24 | 137.80 |
| FNPHC total | 125.52 | 561.08 | 686.60 | 127.90 | 563.97 | 691.87 | 134.68 | 597.30 | 731.99 | 133.49 | 549.81 | 683.30 |
Table 3.
Age-standardised rates of Potentially Preventable Hospitalisations and rank correlations with FNPHC hospitalisation rates, States/Territories.
Table 3.
Age-standardised rates of Potentially Preventable Hospitalisations and rank correlations with FNPHC hospitalisation rates, States/Territories.
| Spearman’s Rank Correlation | ||||||||
|---|---|---|---|---|---|---|---|---|
| Age-Standardised Hospitalisation Rate (per 1000) | PDx | ADx | ||||||
| State/Territory | 2016–2017 | 2017–2018 | 2018–2019 | 2019–2020 | rho | p | rho | p |
| NSW | 51.12 | 53.90 | 53.11 | 51.02 | 0.60 | 0.40 | 0.40 | 0.60 |
| VIC | 51.02 | 59.36 | 61.49 | 64.66 | 0.80 | 0.20 | 0.60 | 0.40 |
| QLD | 72.50 | 78.83 | 80.26 | 78.41 | 0.40 | 0.60 | −0.20 | 0.80 |
| SA | 76.23 | 78.47 | 75.42 | 73.15 | −1.00 | <0.001 | −0.60 | 0.40 |
| WA | 95.65 | 93.50 | 97.55 | 93.93 | 0.80 | 0.20 | 0.40 | 0.60 |
| TAS | 25.04 | 32.01 | 29.66 | 27.76 | 0.60 | 0.40 | 0.60 | 0.40 |
| NT | 135.53 | 136.82 | 144.14 | 133.11 | 0.40 | 0.60 | −0.20 | 0.80 |
| ACT | 42.82 | 37.11 | 37.76 | 47.66 | 1.00 | <0.001 | 0.40 | 0.60 |
| Australia | 70.91 | 74.61 | 75.62 | 73.22 | 0.80 | 0.20 | 0.80 | 0.20 |
Table 4.
Spearman’s rank correlation between principal and additional diagnoses for all observations.
Table 4.
Spearman’s rank correlation between principal and additional diagnoses for all observations.
| FNPHC Category | ρ | p |
|---|---|---|
| Diabetes | 0.79 | <0.001 |
| Respiratory health | 0.96 | <0.001 |
| Circulatory health | 0.77 | <0.001 |
| ARF/RHD | 0.91 | <0.001 |
| CKD | 0.77 | <0.001 |
| Eyes and ears | 0.84 | <0.001 |
| Oral health | −0.04 | 0.81 |
| STI and blood-borne diseases | 0.78 | <0.001 |
| Cancer | 0.14 | 0.44 |
| Depression and suicide | 0.17 | 0.36 |
| Mental disorders | 0.87 | <0.001 |
| Mental-health related | 0.44 | 0.01 |
| Alzheimer’s and dementia | 0.71 | <0.001 |
| Alcohol and drugs | 0.94 | <0.001 |
| Older adults (50+) | 0.21 | 0.25 |
| Lifestyle factors | 0.02 | 0.92 |
| FNPHC total | 0.91 | <0.001 |
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MDPI and ACS Style
Potts, B.; Doran, C.M.; Begg, S.J. A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations. Int. J. Environ. Res. Public Health 2024, 21, 1192. https://doi.org/10.3390/ijerph21091192
AMA Style
Potts B, Doran CM, Begg SJ. A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations. International Journal of Environmental Research and Public Health. 2024; 21(9):1192. https://doi.org/10.3390/ijerph21091192
Chicago/Turabian StylePotts, Boyd, Christopher M. Doran, and Stephen J. Begg. 2024. "A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations" International Journal of Environmental Research and Public Health 21, no. 9: 1192. https://doi.org/10.3390/ijerph21091192
APA StylePotts, B., Doran, C. M., & Begg, S. J. (2024). A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations. International Journal of Environmental Research and Public Health, 21(9), 1192. https://doi.org/10.3390/ijerph21091192
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