skip to navigation | skip to content

The Clinical Excellence Commission The eChartbook


ACUTE AND OTHER SERVICES’ INDICATORS
CEC eChartbook
Potentially Avoidable Deaths
 
 


Why is this important?


One approach to assess the safety and quality of health care is to identify deaths that should not have occurred, given available health care interventions  [1]. The concept of potentially avoidable deaths (PAD) was introduced in 1976 by Rutstein  [2]. In the early development, the original aim of PAD was to identify aspects of care that caused such deaths, so detailed investigation could be launched. PAD definition was later refined to reflect differences between causes amenable to health care and those preventable through public health interventions. In the context of safety and quality in health care, amenable deaths are more relevant, and they will be the focus of this report.


Over the past four decades PAD amenable to health care have been re-defined after taking account of improved health care and increased life expectancy. Its aim has now been to assess performance of health systems in terms of variation and efficiency. The list of amenable deaths has also undergone substantial changes from an expert consensus approach in the early development to an evidence-based approach.


The Australian definition of PAD is aligned with recent international developments modified to align with healthcare interventions within an Australian context [3]. In this regard, PAD amenable to health care are defined as deaths in persons less than 75 years of age, from conditions that are potentially preventable through individualised care and/or treatable through existing primary or hospital care  [4]. The selected causes of deaths are specified on the National Healthcare Agreement (NHA): PI 16-Potenitally avoidable deaths (2015) [4]. The corresponding International Classification of Disease (ICD-10) codes of all avoidable conditions are provided in "Data Definitions".



References

[1] Page A, Tobias M, Glover J, Wright C, Hetzel D, Fisher E. (2006) Australian and New Zealand Atlas of Avoidable Mortality. Adelaide: Public Health Information Development Unite, University of Adelaide.
[2] Rutstein DD, Berenberg W, Chalmers TC, Child CG, 3rd, Fishman AP, Perrin EB. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976; 294(11):582-588.
[3] AMIEHS. Avoidable mortality in the European Union: Towards better indicators for the effectiveness of health systems. European Union Public Health Program 2007 106. Available at:  http://amiehs.lshtm.ac.uk/publications/. Accessed: 12 May, 2016.
[4] AIHW 2015b. METeOR (Metadata Online Registry). National Healthcare Agreement. PI 16 – Potentially avoidable deaths, 2015. Canberra: AIHW. Viewed 1 February 2016. Available at: http://meteor.aihw.gov.au/content/index.phtml/itemId/559036


Findings


Potentially avoidable deaths of NSW residents were presented for 4 periods (two-calendar year averages); 2009-2010, 2010-2011, 2011-2012 and 2012-2013. On average, there were 49,218 deaths from all causes per year during this period. Of this, 1 in 3 deaths occurred among people younger than 75 (premature deaths (n=16,382)). One in 2 premature deaths were considered potentially avoidable (n=8,150).  The age standardised PAD rate in NSW steadily declined from 114 in 2009-2010 to 105 per 100,000 population in 2012-2013 (Chart PAD01). This decline was also observed for males (Chart PAD02) and females (Chart PAD03) with overall 7.5 and 7.7 per cent reduction respectively, over the period.

PAD rates fluctuated across local health districts (LHDs). The decline in the standardised PAD rate was greater in Metropolitan NSW LHDs (Central Coast, Illawarra Shoalhaven, Nepean Blue Mountains, Northern Sydney, South Eastern Sydney, South Western Sydney, Sydney and Western Sydney) than the Rural & regional NSW LHDs. The same pattern was observed for males and females. Avoidable deaths varied by rurality/remoteness and socioeconomic status. PAD Rates in very remote regions were significantly higher than those in major cities (Chart PAD04), while rates for people in the most socioeconomically disadvantaged quintiles were almost twice as high as for people in the least disadvantaged quintiles (Chart PAD05).


Implications


Potentially avoidable deaths are indicative of selected causes of death amenable to current healthcare interventions. With increasing growth in health services, there is a pressing need to monitor and evaluate health and clinical outcomes on regular basis. Longitudinal comparisons showing demographic, geographic and socioeconomic variations (Charts PAD04 and PAD05) point to priority areas for further detailed investigation of specific causes and interventions.   This will ensure that inappropriate, poor quality or unsafe care can be identified, the causes of clinical variation as well as geographic & social variations will be understood and that the health care investment results in improved health for individuals and populations [3].



References

[3] AMIEHS. Avoidable mortality in the European Union: Towards better indicators for the effectiveness of health systems. European Union Public Health Program 2007 106. Available at:  http://amiehs.lshtm.ac.uk/publications/. Accessed: 12 May, 2016.


What we don't know


PAD is linked to geographic, socio-demographic and cultural factors, but the relationship is complex. Lower SES areas and rural and remote areas typically have higher rates of PAD but also have higher rates of people with chronic and complex comorbidities. Further investigations into the causal relationship between PAD and these factors will provide useful information about the relationship to patient safety and quality care.


Chart PAD01 - Potentially avoidable deaths (PAD) by LHD, persons
 

PAD rate per 100,000 persons under 75 years of age, by LHD and NSW,
2009-2010 to 2012-2013 (2-calendar-year averages)


eChartbook
Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed  (27 January 2016).


Chart PAD02 – Potentially avoidable deaths (PAD) by LHD, males
 

PAD rate per 100,000 males under 75 years of age, by LHD and NSW,
2009-2010 to 2012-2013 (2-calendar-year averages)


eChartbook
Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed  (27 January 2016).


Chart PAD03 – Potentially avoidable deaths (PAD) by LHD, females
 

PAD rate per 100,000 females under 75 years of age, by LHD and NSW,
2009-2010 to 2012-2013 (2-calendar-year averages)


eChartbook

Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed  (27 January 2016).



Chart PAD04 – Potentially avoidable deaths (PAD) by remoteness (ARIA index)
 

PAD rate per 100,000 females under 75 years of age, by LHD and NSW,
2009-2010 to 2012-2013 (2-calendar-year averages)


eChartbook
Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed  (27 January 2016).


Chart PAD05 – Potentially avoidable deaths (PAD) by socioeconomic status (SEIFA index)
 

PAD rate per 100,000 persons under 75 years of age by socioeconomic status,
2009-2010 to 2012-2013 (2-calendar-year averages)


eChartbook
Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed  (8 February 2016).


End Matter


Contributors
Drafted by: CEC eChartbook team
Data analysis by: CEC eChartbook team
Reviewed by: Helen Moore,  Lee Taylor, Centre for Epidemiology and Evidence, NSW Ministry of Health
Edited by: CEC eChartbook team


Suggested citation
Clinical Excellence Commission [access year]. eChartbook Portal: Safety and Quality of Healthcare in New South Wales. Sydney: Clinical Excellence Commission. Available at: http://www.cec.health.nsw.gov.au/echartbook/acute-and-other-services-indicators/pad Accessed (insertdate of access).


© Clinical Excellence Commission 2016
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Clinical Excellence Commission (CEC). Requests and enquiries concerning reproduction and rights should be directed to the Director, Corporate Services, Locked Bag 8, Haymarket NSW 1240.


Evidence-base for this initiative

Gillespie et al. Interventions for preventing falls in older people living in the community (Review)
The Cochrane Library, 2009, Issue 4
http://www.mnfallsprevention.org/downloads/Review-Interventions-for-preventing-falls.pdf


Reported elsewhere
Health Statistics New South Wales - www.healthstats.nsw.gov.au



Definitions


Chart: PAD01

Admin Status: Data from 2009-2010 to 2012-2013

Indicator Name: Potentially avoidable deaths by local health district, persons under 75 years of age

Description: Age standardised potentially avoidable deaths per 100,000 persons under 75 years of age, by local health district of residence, NSW, 2009-2010 to 2012-2013 (2-calendar-year averages)

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Deaths of NSW residents that were potentially avoidable, the ICD-10 codes in principal diagnosis of potentially avoidable death (PAD) are listed below (in Comments).

Data Exclusions: Deaths of non-NSW residents

Numerator: Deaths of persons aged under 75 years that were potentially avoidable

Denominator: NSW estimated residential population for persons aged under 75 years

Standardisation: Direct age standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP)

Data Source: Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (27 January 2016).

Comments:

Note on the data: Avoidable mortality by selected cause – 0 to 74 years, produced by PHIDU, available at http://www.publichealth.gov.au/phidu//help-info/about-our-data/indicators-notes/sha-aust/health-status/deaths-0-74-avoidable-transport-accidents.html, accessed on 01-02-2016. “In 2010, the National Healthcare Agreement (NHA) included a performance indicator called Potentially Avoidable Deaths (PI-20). The specification for this indicator was endorsed by the Australian Health Ministers’ Advisory Council in 2009 based on advice from the National Health Information Standards and Statistics Committee (NHISSC). On 4 December 2013, NHISSC agreed to the re-establishment of the Potentially Preventable Hospitalisations/Potentially Avoidable Deaths (PPH/PAD) Working Group to finalise specification of this performance indicator for the 2015 NHA report. Throughout 2014, work was done by the PPH/PAD Working Group, with further revisions by the Australian Institute of Health and Welfare (AIHW), and including additional NHISSC comments from several states. It also included an examination of the international work in avoidable mortality. As a result of this work, the National Healthcare Agreement (NHA) (2015) Health, Standard 14/01/2015 now includes the PI-16 Potentially avoidable deaths, 2015, and these are presented in this dataset. Further revisions of this NHA

Potentially avoidable deaths standard are proposed.” Potentially avoidable deaths International Classification of Disease (ICD-10) codes based on the PI-16 Potentially avoidable deaths, 2015 are shown below.

 

Cause of death groups

ICD-10 Codes

Limits (age, sex)

Infections

  

Selected invasive infections

A38–A41, A46, A48.1, G00, G03, J02.0, J13–J16, J18, L03

 

Viral pneumonia and influenza

J10–J12

 

HIV/AIDS

B20–B24

 

Cancer

  

Colorectal

C18–C21

 

Skin

C43, C44

 

Breast

C50

Female

Cervix

C53

 

Prostate

C61

 

Kidney

C64

 

Thyroid

C73

 

Hodgkin's disease

C81

 

Acute lymphoid leukaemia/Acute lymphoblastic leukaemia

C91.0

0-44 years

Diabetes

E10–E14

 

Diseases of the circulatory system

  

Rheumatic and other valvular heart disease

I00–I09, I33–I37

 

Hypertensive heart and renal disease

I10–I13

 

Ischaemic heart disease

I20–I25

 

Cerebrovascular diseases

I60–I69

 

Heart failure

I50, I51.1, I51.2, I51.4, I51.5

 

Pulmonary embolism

I26

 

Diseases of the genitourinary system

  

Renal failure

N17–N19

 

Diseases of the respiratory system

  

COPD

J40–J44

 

Asthma

J45, J46

 

Diseases of the digestive system

  

Pepticulcer disease

K25–K27

 

Maternal & infant causes

  

Complications of the perinatal period

P00–P96

 

Other conditions

  

Complications of pregnancy, labour or the puerperium

O00–O99

 

Selected external causes of morbidity and mortality

  

Falls

W00–W19

 

Fires, burns

X00–X09

 

Suicide and self-inflicted injuries

X60–X84, Y87.0

 

Misadventures to patients during surgical and medical care

Y60–Y69

 

Medical devices associated with adverse incidents in diagnostic and therapeutic use

Y70–Y82

 

Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication,
without mention of misadventure at the time of the procedure

Y83, Y84

 

Other external causes of morbidity and mortality

  

Transport accidents

V01–V99

 

Exposure to inanimate mechanical forces

W20–W49

 

Exposure to animate mechanical forces

W50–W64

 

Accidental drowning and submersion

W65–W74

 

Other accidental threats to breathing

W75–W84

 

Exposure to electric current, radiation and extreme ambient air temperature and pressure

W85–W99

 

Contact with heat and hot substances

X10–X19

 

Contact with venomous animals and plants

X20–X29

 

Exposure to forces of nature

X30–X39

 

Accidental poisoning by and exposure to noxious substances

X40–X49

 

Overexertion, travel and privation

X50–X57

 

Accidental exposure to other and unspecified factors

X58,X59

 

Assault

X85–Y09

 

Event of undetermined intent

Y10–Y34

 

Legal interventions and operations of war

Y35, Y36

 

Drugs, medicaments and biological substances causing adverse effects in therapeutic use

Y40–Y59

 

Sequelae of external causes of morbidity and mortality

Y85, Y86, Y87.1–Y89

 
 
Chart: PAD02

Admin Status: Data from 2009-2010 to 2012-2013

Indicator Name: Potentially avoidable deaths by local health district, males under 75 years of age

Description: Age standardised potentially avoidable deaths per 100,000 males under 75 years of age, by local health district of residence and NSW, 2009-2010 to 2012-2013 (2-calendar-year averages)

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Age standardised potentially avoidable deaths per 100,000 males under 75 years of age, by local health district of residence and NSW, 2009-2010 to 2012-2013 (2-calendar-year averages)

Data Exclusions: Deaths of non-NSW males

Numerator: Deaths of NSW males aged under 75 years that were potentially avoidable

Denominator: NSW estimated residential males under 75 years of age

Standardisation: Direct age standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP), males only

Data Source: Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (27 January 2016).

Comments: Please see Comments in Chart PAD01.
 
Chart: PAD03

Admin Status: Data from 2009-2010 to 2012-2013

Indicator Name: Potentially avoidable deaths by local health district, females under 75 years of age

Description: Age standardised potentially avoidable deaths per 100,000 females under 75 years of age, by local health district of residence and NSW, 2009-2010 to 2012-2013 (2-calendar-year averages)

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Deaths of NSW females that were potentially avoidable, the ICD-10 codes in principal diagnosis of potentially avoidable death (PAD) are listed in the Comments (Chart PAD01).

Data Exclusions: Deaths of non-NSW females

Numerator: Deaths of females aged under 75 years that were potentially avoidable

Denominator: NSW estimated residential females under 75 years of age

Standardisation: Direct age standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP), females only

Data Source: Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (27 January 2016).

Comments: Please see Comments in Chart PAD01.
 
Chart: PAD04

Admin Status: Data from 2009-2010 to 2012-2013

Indicator Name: Potentially avoidable deaths by remoteness from service centres (ARIA), persons under 75 years of age

Description: Age standardised potentially avoidable deaths per 100,000 persons under 75 years of age, by local health district of residence, NSW, 2009-2010 to 2012-2013 (2-calendar-year averages)

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Deaths of NSW residents that were potentially avoidable, the ICD-10 codes in principal diagnosis of potentially avoidable death (PAD) are listed below (in Comments).

Data Exclusions: Deaths of non-NSW residents

Numerator: Deaths of persons aged under 75 years that were potentially avoidable

Denominator: NSW estimated residential population for persons aged under 75 years

Standardisation: Direct age standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP)

Data Source: Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (27 January 2016).

Comments: Please see comments in Chart PAD01.
 
Chart: PAD05

Admin Status: Data from 2009-2010 to 2012-2013

Indicator Name: Potentially avoidable deaths by socioeconomic status (SEIFA), persons under 75 years of age

Description: Age standardised potentially avoidable deaths per 100,000 persons under 75 years of age, by socioeconomic status (SEIFA index), 2009-2010 to 2012-2013 (2-calendar-year averages)

Dimension: Appropriateness

Clinical Area: Population Health and Primary Care

Data Inclusions: Deaths of NSW residents that were potentially avoidable, the ICD-10 codes in principal diagnosis of potentially avoidable death (PAD) are listed in the Comments (Chart PAD01).

Data Exclusions: Deaths of non-NSW residents

Numerator: Deaths of persons aged under 75 years that were potentially avoidable

Denominator: NSW estimated residential population for persons aged under 75 years

Standardisation: Direct age standardisation to the 2001 Australian mid-year Estimated Resident Population (ERP)

Data Source: Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (8 February 2016).

Comments: Please see comments in Chart PAD01.