Coordination of Health Care Study: Use of Hospitals and Emergency Departments, Australia

Australia’s health system is a complex mix of health professionals and service providers from a range of organisations—across all levels of government and the non-government sector. Collectively, they work to meet the health care needs of all Australians. Hospitals are an important part of this system, delivering a wide range of clinical services including treatment, care and rehabilitation¹.

Understanding patients’ experiences and their interactions with parts of the health system such as hospitals is critical to ensuring that services are delivered appropriately and meet the needs of all Australians. High quality and well-coordinated health care is crucial to enhancing patients’ understanding, control and self-management of their illness² ³, contributing to better health outcomes.

This publication presents findings from the third stage of the Coordination of Health Care Study (the Study) which links information on state and territory hospital admissions and emergency department presentations to the 2016 Survey of Health Care.

For New South Wales, Victoria, Western Australia, Tasmania, the Northern Territory and the Australian Capital Territory, hospital data provided to Australian Bureau of Statistics (ABS) for the Study was sourced from the Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database (NHMD). For Queensland and South Australia, data were sourced from the Queensland Hospital Admitted Patient Data Collection (QHAPDC) and South Australia Public Hospital Separations dataset respectively.

For New South Wales, Victoria, Queensland, Western Australia, Tasmania, the Northern Territory and the Australian Capital Territory, emergency department data provided to ABS for the Study was sourced from the AIHW National Non-admitted Patient Emergency Department Care Database (NNAPEDCD). For South Australia, data were sourced from the South Australia Public Hospital Emergency Department dataset.

The first stage of the Study, the 2016 Survey of Health Care, collected information on respondents' experiences with a range of health care professionals (for example, general practitioners and specialists) and the broader health care system (for example, diagnostic tests, hospital admissions and emergency department visits). The second stage, undertaken in 2018, explored patients’ experiences of coordinated care with health care providers in the context of their use of Medicare Benefits Schedule (MBS) services and Pharmaceutical Benefits Scheme (PBS) medicines.

The Coordination of Health Care Study is funded by the AIHW and is jointly conducted by ABS and the AIHW. This publication was jointly prepared and released by the ABS and the AIHW.

Results in this publication are based on a sample of 25,502 Australians aged 45 years or over who had at least one GP visit between November 2014 and November 2015 and had participated in the 2016 Survey of Health Care. This sample has been weighted to represent the 8.8 million people in Australia aged 45 years and over who had at least one GP visit in this period (the Study cohort).

These 25,502 Study participants consented to linkage of information about the hospital and emergency department services they used between 1 January 2014 and 30 June 2018 to their 2016 Survey of Health Care records.

All linkage is approved by appropriate ethics committees and follows strict confidentiality procedures to ensure Study participants’ personal information is protected.

This publication focusses on participants’ use of hospital and emergency department services in 2015-16 to coincide with the Survey of Health Care reference period of 2016.

There are a number of factors that should be considered when interpreting information presented in this publication:

• data presented relate to hospitalisations and emergency department presentations in 2015-16 (see Glossary for more information). Services provided through outpatient clinics for which patients were not admitted to hospital are not included;
• the scope of hospital information available for linkage differed between states and territories. Data relate to public hospitalisations in all states and territories and private hospitalisations in New South Wales, Victoria, Queensland and Western Australia (see paragraphs 44 to 46 of the Methodology for more information);
• emergency department data relate to services provided at public hospitals that meet the criteria for inclusion in the NNAPEDCD (see paragraphs 54 to 57 of the Methodology for more information). Services provided at private hospital emergency departments are not included in the NNAPEDCD; and
• data on emergency department presentations in the Australian Capital Territory in 2015-16 were not available at the time of publication.

Due to these scope exclusions, geographic-level data in particular should be interpreted with caution. Comparisons between states and territories are not recommended (see the Data Quality section in the Methodology for more information). Additionally, variation in the use of health services across geographies may reflect the different demographic characteristics of these areas (for example, their age structures) as well as other factors such as the availability of particular health services or the way health services are provided.

Estimates in this publication are based on 25,502 people in the Study who provided consent for the release of their hospital and emergency department information to the ABS, from a sample of 35,495 people who participated in the 2016 Survey of Health Care. Potential bias in the consenting sample in addition to the participating sample may affect estimates. Furthermore, as the consenting sample were linked to state/territory administrative data sources, errors in this linkage (for example, non-linkage of records) may also affect estimates. As a result, while estimates in this publication are derived from a subset of information from state/territory hospital and emergency department collections, these estimates will not necessarily be consistent with data sourced directly from these collections.

Future work by the AIHW will combine all stages of the Coordination of Health Care Study. Analysis across the suite of integrated datasets (that is, Survey of Health Care, MBS, PBS, hospital and emergency department information) will build a more comprehensive picture of patient journeys and pathways of care. Themes such as potentially preventable hospitalisations, coordination of care in unplanned hospital readmissions and patient experiences of barriers to accessing care and unmet need may be explored.

This publication presents findings from the third stage of the Coordination of Health Care Study (the Study) which links information on state and territory hospitalisations and emergency department presentations to the 2016 Survey of Health Care. Analysis focusses on use of hospitals and emergency departments in 2015-16 by people aged 45 years and over who had at least one general practitioner (GP) visit between November 2014 to November 2015 (the Study cohort).

• Overall, around one quarter (24%) of people in the Study cohort had at least one hospitalisation in 2015-16.
• Around one in five (18%) people in the Study cohort aged 45-54 years had at least one hospitalisation in 2015-16, increasing to almost two in five (38%) people aged 85 years and over.
• Around one quarter (26%) of people in the Study cohort who had both a usual GP and a usual place of care went to hospital in 2015-16, compared with 11% of people who did not have a usual GP and did not have a usual place of care.
• More than two in five (43%) people in the Study cohort who rated their health as poor had at least one hospitalisation in 2015-16, compared with 14% of people who rated their health as excellent.
• Of people in the Study cohort who had three or more long-term health conditions, around one-third (36%) had at least one hospitalisation in 2015-16 compared with 15% of people who did not have a long-term health condition.
   

• Overall, around 15% of people in the Study cohort had at least one emergency department presentation in 2015-16.
• Around 12% of people in the Study cohort aged 45-54 years had at least one emergency department presentation in 2015-16, compared with 28% of people aged 85 years and over.
• There was little difference between the proportion of people in the Study cohort who had both a usual GP and a usual place of care who attended an emergency department in 2015-16 (15%) and the proportion of people who did not have a usual GP and did not have a usual place of care who attended an emergency department in 2015-16 (12%).
• Around one in five (18%) people in the Study cohort living in areas of most disadvantage of Australia had at least one emergency department presentation in 2015-16, compared with one in nine (11%) people living in areas of least disadvantage.
• Of people in the Study cohort who rated their health as poor, around one in three (35%) had at least one emergency department presentation in 2015-16, compared with 7% of people who rated their health as excellent.
• Around one in four (23%) people in the Study cohort who had three or more long-term health conditions had at least one emergency department presentation in 2015-16, compared with 8% of people who did not have a long-term health condition.

Hospitals in Australia provide a range of treatments and services for admitted patients, such as medical, surgical and other acute care, along with mental health care and subacute (for example, rehabilitation) and non-acute care¹.

This section provides an overview of the use of hospitals in 2015-16 by people aged 45 years and over who had at least one GP visit between November 2014 and November 2015 (the Study cohort). A hospitalisation is a completed episode of admitted hospital care ending with discharge, death or transfer—or a portion of a hospital stay starting or ending in a change to another type of care (for example, from acute care to rehabilitation)².

Data include public hospitalisations in all states and territories and private hospitalisations in New South Wales, Victoria, Queensland and Western Australia (see the Data Quality section in the Methodology for more information).

Overall, around one quarter (24%) of people in the Study cohort had at least one hospitalisation in 2015-16, comprising 15% who had one hospitalisation, 8% who had two to four hospitalisations and 2% who had five or more hospitalisations. This proportion (24%) is similar to the proportion of people who self-reported in the 2016 Survey of Health Care being admitted to hospital in the last 12 months (22%; see paragraph 47 of the Methodology).

The proportion of people who went to hospital in 2015-16 increased with age. Around one in five (18%) people in the Study cohort aged 45-54 years had at least one hospitalisation in 2015-16, increasing to around two in five (38%) people aged 85 years and over. Overall, similar proportions of men and women in the Study cohort went to hospital in 2015-16 (25% and 24% respectively).

In the Study, a usual GP is defined as the GP that people go to for most of their health care, while a usual place of care is the usual place that people go if they are sick or need advice about their health (for example, a clinic with GPs and other health professionals).

Around one quarter (26%) of people in the Study cohort who had both a usual GP and a usual place of care went to hospital in 2015-16, compared with 11% of people who did not have a usual GP and did not have a usual place of care. The higher proportion of people who had both a usual GP and a usual place of care who went to hospital in 2015-16 may reflect their higher health care needs compared with people who did not have a usual GP and did not have a usual place of care. For example, results from the 2016 Survey of Health Care indicate that amongst people with both a usual GP and a usual place of care, around one in three (30%) had three or more long-term health conditions. Of people who did not have a usual GP and did not have a usual place of care, one in ten (10%) had three or more long-term health conditions.

Study participants were asked to rate their health on a 5-point scale ranging from poor to excellent. Overall, more than two in five (43%) people who rated their health as poor had at least one hospitalisation in 2015-16, compared with 14% of people who rated their health as excellent.

People who rated their health as poor were more likely to have had multiple hospitalisations than people who rated their health more highly. Around 9% of people who rated their health as poor had five or more hospitalisations in 2015-16, compared with less than 1% of people who rated their health as excellent.

Study participants were asked to identify particular long-term health conditions they had (for example, diabetes or heart disease). Of people who had three or more long-term health conditions, around one-third (36%) had at least one hospitalisation in 2015-16 compared with 15% of people who did not have a long-term health condition.

Emergency departments provide care for patients with life-threatening or urgent medical needs, as well as serving as a first point of contact with the health system for patients who are unable to access other services. Emergency departments may admit patients to hospital or to other health care services¹.

This section provides an overview of the use of emergency departments in 2015-16 by people aged 45 years and over who had at least one GP visit between November 2014 and November 2015 (the Study cohort). An emergency department presentation is the arrival of a patient at an emergency department that results in clerical registration or triage².

For New South Wales, Victoria, Queensland, Western Australia, Tasmania, the Northern Territory and the Australian Capital Territory, data include emergency department presentations at public hospitals sourced from the AIHW National Non-admitted Patient Emergency Department Care Database. For South Australia, data were sourced from the South Australia Public Hospital Emergency Department dataset (see the Data Quality section in the Methodology for more information).

Overall, around 15% of people in the Study cohort had at least one emergency department presentation in 2015-16, comprising 10% who had one presentation, 3% who had two presentations and 2% who had three or more presentations. This proportion (15%) is slightly lower than the proportion of people who self-reported in the 2016 Survey of Health Care that they had been to an emergency department in the last 12 months (18%; see paragraph 58 of the Methodology).

The proportion of people who attended an emergency department in 2015-16 increased with age. Around 12% of people in the Study cohort aged 45-54 years had at least one emergency department presentation in 2015-16, compared with 28% of people aged 85 years and over. Overall, similar proportions of men and women in the Study cohort attended an emergency department in 2015-16 (15% and 14% respectively).

In the Study, a usual GP is defined as the GP that people go to for most of their health care, while a usual place of care is the usual place that people go if they are sick or need advice about their health (for example, a clinic with GPs and other health professionals).

In contrast to the differences in hospitalisations, there was little difference between the proportion of people in the Study cohort who had both a usual GP and a usual place of care who attended an emergency department in 2015-16 (15%) and the proportion of people who did not have a usual GP and did not have a usual place of care who attended an emergency department in 2015-16 (12%).

Continuity of care and accumulated professional knowledge about individual patients and their health are especially important for patients with chronic and/or multiple conditions who typically have to use health services regularly³,⁴. The higher proportion of people in the Study cohort who had both a usual GP and a usual place of care who went to hospital in 2015-16 may reflect better overall management and coordination of care for these patients by their usual GP and place of care, who can take into account patient needs and communication and connectivity between health care providers including primary care and hospital settings for planned hospital admissions⁵, as opposed to unplanned emergency department presentations.

Around one in five (18%) people in the Study cohort living in areas of most disadvantage of Australia (quintile 1; see Socio-Economic Indexes for Areas in the Glossary) had at least one emergency department presentation in 2015-16, compared with one in nine (11%) people living in areas of least disadvantage (quintile 5). In general, people living in areas of higher disadvantage experience poorer health. For example, results from the 2016 Survey of Health Care indicate that amongst people living in areas of most disadvantage, around one third (35%) had three or more long-term health conditions. Of people living in areas of least disadvantage, around one fifth (21%) had three or more long-term health conditions.

Study participants were asked to rate their health on a 5-point scale ranging from poor to excellent. Of people who rated their health as poor, around one in three (35%) had at least one emergency department presentation in 2015-16, compared with 7% of people who rated their health as excellent.

Study participants identified particular long-term health conditions they had (for example, diabetes or heart disease). Around one in four (23%) people who had three or more long-term health conditions had at least one emergency department presentation in 2015-16, compared with 8% of people who did not have a long-term health condition.

To view the 2016 Survey of Health Care Questionnaire click here

This release previously used catalogue number 4343.0.55.002.