Centre for Health Research

The APHID study (Assessing Preventable Hospitalisation InDicators) is an investigation into the validity and utility of Potentially Preventable Hospitalisations (also known as hospitalisations for Ambulatory Care Sensitive Conditions). Rates of potentially preventable hospitalisations (PPH) are regarded as an indicator of the quality and affordability of primary and community care, and are increasingly being used to track the progress of health reform in Australia and internationally.

Rationale:

Much research has focussed on the relationships between Potentially Preventable Hospitalisations and measures of health system performance, either access to primary care, affordability of primary care, or quality of primary care. However, there remain questions on the validity and generalisability of these measures. Most of the existing research is from the US, and this is of unknown applicability to other health systems. Furthermore, most studies used cross sectional designs on aggregate data, which are not able to tease out the complex interactions between a person’s health care needs, disposition to use health services, and their access to both hospital and primary care. Furthermore, little is known on the impact PPH admissions have on health outcomes for people with chronic disease, particularly the role they play in areas where access to primary health services are poor.

Design and method:

The study uses data linkage study for participants in the 45 and Up study, a prospective cohort of 265,000 men and women aged 45 and over in NSW.

Information on personal demographics, self-reported health status, and risk behaviour from the 45 and Up Study baseline questionnaire is linked with information on Medicare-funded health service use in the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme (MBS and PBS), statewide health service use in the NSW Admitted Patient Data Collection and the NSW Emergency Department Data Collection (APDC and EDDC), and mortality information from the Register of Births, Death and Marriages and Australian Bureau of Statistics (RBDM and ABS) deaths data sets.

Using linked person-level data, we will explore relationships between frequency, volume, nature and costs of primary care services, hospital admissions for PPH diagnoses, and health outcomes, and factors that confound and mediate these relationships. Using multilevel modelling techniques, we will quantify the contributions of person-, geographic- and service-level factors to variation in PPH rates, including socioeconomic status, country of birth, geographic remoteness, physical and mental health status, availability of general practitioner (GP) and other services, and hospital characteristics.

With the partner agencies, we will use these findings to make recommendations regarding the ongoing use of PPH measures to inform clinical interventions and public reporting and monitor the impacts of health reform in Australia.

Collaborating institutions:

The study is a partnership between the University of Western Sydney, the MRC Social and Public Health Sciences Unit (Glasgow), the University of Sydney, the Australian National University, the University of Aberdeen, the Sax Institute, the Australian Commission on Safety and Quality in Health Care, the NSW Bureau of Health Information and the NSW Agency for Clinical Innovation. The Study is funded by an NHMRC Partnership Project Grant.

Chief and Associate Investigators:

Louisa Jorm
Alastair Leyland
Fiona Blyth
Robert Elliott
Kirsty Douglas
Sally Redman
Neville Board
Danielle Butler
Douglas Lincoln
Sanja Lujic
Kate Needham
Damilola Olajide
Kim Sutherland
Diane Watson
Hunter Watt
Marjon van der Pol

Study Contact:

Michael Falster, Research Fellow and Project Coordinator - michael.falster@uws.edu.au