Barkly, Northern Territory has the highest rates of potentially preventable hospitalisations across five top chronic conditions – but experts say Health Care Homes could help
The Atlas of Healthcare Variation, published this month by the Australian Commission on Safety and Quality in Health Care, reveals that almost half (47%) of potentially preventable hospitalisations in Australia in 2014-15 were due to five conditions:
- Chronic obstructive pulmonary disease (COPD)
- Kidney infections and urinary tract infections (UTIs)
- Heart failure
- Diabetes complications
Five areas in remote parts of Australia (Kimberley, Alice Springs, Outback—South, Far North, and Outback—North) were found to have hospitalisation rates that were more than double the national rate.
The Barkly region of the Northern Territory topped four out of five categories except for COPD, coming second after East Arnhem which is also in the Northern Territory.
Barkly has an estimated population of 8,168 people, while East Arnhem has nearly 11,000. Meanwhile the Kimberley region (which also rated very poorly across all categories) has a population of over 50,000.
Variation between local areas across Australia was greatest for COPD—with a 16-fold difference between areas.
The Northern Territory dominated the highest-rate areas of potentially preventable hospitalisation due to COPD (see above).
Smoking is the most common cause of COPD, says the Atlas, and rates of smoking are high in regional and remote areas, and among people with socioeconomic disadvantage.
Diabetes complications also had a high (12-fold) difference between localities.
Several regions in NSW, including Manly, the Blue Mountains, Baulkham Hills, the Eastern suburbs, North Sydney, Mosman, Dural, Pennant Hills/Epping, and Ku-Ring-Gai had the lowest rates of potentially preventable hospitalisation due to diabetes complications.
Meanwhile the Northern Territory and Queensland dominated the highest rate areas for potentially preventable diabetes complications, with Barkly topping the list far and away.
The Atlas points to food insecurity and socioeconomic disadvantage as contributing factors behind diabetes prevalence, adding that poor management of diabetes increases the risk of complications.
“Access to comprehensive, systematic care and follow-up reduces complications and preventable hospitalisations among people with diabetes.”
Mapping variation is an invaluable tool for understanding how our healthcare system is providing care, but gathering the data is only the first step, explains the Commission.
“Understanding the underlying reasons for marked differences in the use of some health services across Australia, and considering how we can improve, are key for translating this work into better outcomes for patients.
“The high hospitalisation rates and substantial variation reported for the chronic diseases … show that recommended care is not always provided for people with these conditions,” it says.
“Even with the significant funding provided through Medicare to better coordinate primary care for people with complex chronic disease, fragmented health services contribute to suboptimal management.
“The implementation of a Health Care Home (HCH) model will greatly improve appropriateness and coordination of care for patients with multiple chronic and complex conditions.”
The Commission points out that poor access to health services in the community is related to higher rates of potentially preventable hospitalisations.
It suggests “enhanced access” to HCH care through in-hours support by telephone, email and videoconferencing, as well as after-hours advice or care.
The Atlas also looked deeper into cardiovascular conditions, women’s health and surgical interventions.
Its general recommendations included:
- Promoting routine measurement and recording of obesity markers.
- Develop methods for estimating population needs of specific interventions.
- Identifying best-practice models for the introduction of new technology in the Australian clinical setting.
- Investigation into variation in healthcare and how to improve appropriateness of care.
- To continue to monitor variation in clinical practice and patient outcomes, and take action to improve care and reduce variation.
- For the Commission to work with the Australian Institute of Health and Welfare, state and territory health departments to use linked data for examining variations – with cardiovascular disease to be an initial priority of this work.
- AHPRA to expand data collection on clinician location of practice so extent of practice in regional and remote areas is quantified.
The first Australian Atlas of Health Variation was released in November 2015, and examined prescribing, diagnostic, medical and surgical interventions.