National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2015

Identifying and definitional attributes
Metadata item type:	Indicator
Indicator type:	Progress measure
Short name:	PI 23-Unplanned hospital readmission rates, 2015
METEOR identifier:	559020
Registration status:	Health, Superseded 08/07/2016
Description:	Unplanned and unexpected hospital readmissions to the same public hospitals within 28 days for selected surgical procedures.
Indicator set:	National Healthcare Agreement (2015) Health, Superseded 08/07/2016
Outcome area:	Hospital and Related Care National Health Performance Authority (retired), Retired 01/07/2016 Health, Standard 07/07/2010
Quality statement:	National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2015 QS Health, Superseded 08/07/2016

Collection and usage attributes

Computation description:

Unplanned/unexpected readmissions are those readmissions where the principal diagnosis indicates an adverse event.

Principal diagnoses codes

A principal diagnosis for the readmission has one of the following ICD-10-AM (7th Ed) codes: T80–88, T98.3, E89, G97, H59, H95, I97, J95, K91, M96 or N99.

T80 Complications following infusion, transfusion and therapeutic injection

T81 Complications of procedures, not elsewhere classified

T82 Complications of cardiac and vascular prosthetic devices, implants and grafts

T83 Complications of genitourinary prosthetic devices, implants and grafts

T84 Complications of internal orthopaedic prosthetic devices, implants and grafts

T85 Complications of other internal prosthetic devices, implants and grafts

T86 Failure and rejection of transplanted organs and tissues

T87 Complications peculiar to reattachment and amputation

T88 Other complications of surgical and medical care, not elsewhere classified

T98.3 Sequelae of complications of surgical and medical care, not elsewhere classified

E89 Postprocedural endocrine and metabolic disorders, not elsewhere classified

G97 Postprocedural disorders of nervous system, not elsewhere classified

H59 Postprocedural disorders of eye and adnexa, not elsewhere classified

H95 Postprocedural disorders of ear and mastoid process, not elsewhere classified

I97 Postprocedural disorders of circulatory system, not elsewhere classified

J95 Postprocedural respiratory disorders, not elsewhere classified

K91 Postprocedural disorders of digestive system, not elsewhere classified

M96 Postprocedural musculoskeletal disorders, not elsewhere classified

N99 Postprocedural disorders of genitourinary system, not elsewhere classified

Procedure codes

Number of separations in which one of the following surgical procedures was undertaken: knee replacement; hip replacement; tonsillectomy and adenoidectomy; hysterectomy; prostatectomy; cataract surgery; appendicectomy.

The following is a list of the specific ACHI (7th Ed) procedure codes which are included in the specifications for each of the selected surgical procedures.

Procedure	Procedure Codes	Description
Knee replacement	49518-00	Total arthroplasty of knee, unilateral
	49519-00	Total arthroplasty of knee, bilateral
	49521-02	Total arthroplasty of knee with bone graft to tibia, unilateral
Hip replacement	49318-00	Total arthroplasty of hip, unilateral
	49319-00	Total arthroplasty of hip, bilateral
Tonsillectomy and adenoidectomy	41789-00	Tonsillectomy without adenoidectomy
	41789-01	Tonsillectomy with adenoidectomy
	41801-00	Adenoidectomy without tonsillectomy
Hysterectomy	35653-01	Total abdominal hysterectomy
	35653-04	Total abdominal hysterectomy with removal of adnexa
	35661-00	Abdominal hysterectomy with extensive retroperitoneal dissection
	35670-00	Abdominal hysterectomy with radical excision of pelvic lymph nodes
	35756-00	Laparoscopically assisted vaginal hysterectomy proceeding to abdominal hysterectomy
	35756-03	Laparoscopically assisted vaginal hysterectomy proceeding to abdominal hysterectomy with removal of adnexa
	90448-01	Total laparoscopic abdominal hysterectomy
	90448-02	Total laparoscopic abdominal hysterectomy with removal of adnexa
	35657-00	Vaginal hysterectomy
	35673-02	Vaginal hysterectomy with removal of adnexa
	35667-00	Radical abdominal hysterectomy
	35664-00	Radical abdominal hysterectomy with radical excision of pelvic lymph nodes
	35664-01	Radical vaginal hysterectomy with radical excision of pelvic lymph nodes
	35667-01	Radical vaginal hysterectomy
	90443-00	Other excision of uterus

Prostatectomy	37207-00	Endoscopic laser ablation of prostate (includes TULIP)
	37201-00	Transurethral needle ablation of prostate
	37203-00	Transurethral resection of prostate
	37203-02	Transurethral electrical vaporisation of prostate
	37203-04	Microwave thermotherapy of prostate
	37203-05	High intensity focussed ultrasound (transrectal) of prostate
	37207-01	Endoscopic laser excision of prostate
	37200-03	Suprapubic prostatectomy
	37200-04	Retropubic prostatectomy
	37224-00	Endoscopic destruction of prostatic lesion
	37224-01	Endoscopic resection of prostatic lesion
	90407-00	Excision of other lesion of prostate
	37203-03	Cryoablation of prostate
Cataract surgery	42698-00	Intracapsular extraction of crystalline lens
	42702-00	Intracapsular extraction of crystalline lens with insertion of foldable artificial lens
	42702-01	Intracapsular extraction of crystalline lens with insertion of other artificial lens
	42698-01	Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique
	42702-02	Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique with insertion of foldable artificial lens
	42702-03	Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique with insertion of other artificial lens
	42698-02	Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract
	42702-04	Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract with insertion of foldable artificial lens
	42702-05	Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract with insertion of other artificial lens
	42698-03	Extracapsular crystalline lens extraction by mechanical phacofragmentation and aspiration of cataract
	42702-06	Extracapsular crystalline lens extraction by mechanical phacofragmentation and aspiration of cataract with insertion of foldable artificial lens
	42702-07	Extracapsular crystalline lens extraction by mechanical phacofragmentation and aspiration of cataract with insertion of other artificial lens
	42698-04	Other extracapsular extraction of crystalline lens
	42702-08	Other extracapsular extraction of crystalline lens with insertion of foldable artificial lens
	42702-09	Other extracapsular extraction of crystalline lens with insertion of other artificial lens
	42731-01	Extraction of crystalline lens by posterior chamber sclerotomy with removal of vitreous
	42698-05	Other extraction of crystalline lens
	42702-10	Other extraction of crystalline lens with insertion of foldable artificial lens
	42702-11	Other extraction of crystalline lens with insertion of other artificial lens
Appendicectomy	30571-00	Appendicectomy
	30572-00	Laparoscopic appendicectomy

Limited to public hospitals.

Denominator limited to separations with a separation date between 1 July and 19 May in the reference year.

Denominator excludes separations where the patient died in hospital.

Analysis by state and territory is based on location of service.

Analysis by remoteness and Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) is based on usual residence of person.

Presented per 1,000 separations.

Computation:

1,000 x (Numerator ÷ Denominator)

Calculated separately for each of the specified procedures

Numerator:

Number of separations for public hospitals which meet all of the following criteria:

The separation is a readmission to the same hospital following a separation in which one of the following procedures was performed: knee replacement; hip replacement; tonsillectomy and adenoidectomy; hysterectomy; prostatectomy; cataract surgery; appendicectomy (see procedure codes in computation description field)
The readmission occurs within 28 days of the previous date of separation
A principal diagnosis for the readmission has one of the following ICD-10-AM codes: T80–88, T98.3, E89, G97, H59, H95, I97, J95, K91, M96 or N99

Numerator data elements:

Data Element / Data Set

Episode of admitted patient care—admission date, DDMMYYYY

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Establishment—sector, code N

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Admitted patient care waiting list episode—scheduled admission date, DDMMYYYY

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Episode of admitted patient care—separation date, DDMMYYYY

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Person—person identifier, XXXXXX[X(14)]

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Episode of care—principal diagnosis, code (ICD-10-AM 7th edn) ANN{.N[N]}

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Episode of admitted patient care—procedure, code (ACHI 7th edn) NNNNN-NN

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Elective surgery waiting list episode—indicator procedure, code NN

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Denominator:

Denominator data elements:

Data Element / Data Set

Episode of admitted patient care—admission date, DDMMYYYY

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Establishment—sector, code N

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Episode of admitted patient care—separation date, DDMMYYYY

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Episode of admitted patient care—procedure, code (ACHI 7th edn) NNNNN-NN

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Disaggregation:

2012–13—Nationally, by specified procedures, by:

peer group
Indigenous status
remoteness (Australian Statistical Geography Standard (ASGS) Remoteness Structure)
2011 Socio-Economic Indexes for Areas (SEIFA) IRSD quintiles

2012–13—State and territory, by specified procedures.

Some disaggregations may result in numbers too small for publication.

Disaggregation data elements:

Data Element / Data Set

Data Element

Hospital peer group

Data Source

National Public Hospital Establishment Database (NPHED)

NMDS / DSS

Public hospital establishments NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Establishment—Australian state/territory identifier, code N

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Person—Indigenous status, code N

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Episode of admitted patient care—procedure, code (ACHI 7th edn) NNNNN-NN

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data

Data Element / Data Set

Person—area of usual residence, statistical area level 2 (SA2) code (ASGS 2011) N(9)

Data Source

National Hospital Morbidity Database (NHMD)

NMDS / DSS

Admitted patient care NMDS 2012-13

Guide for use

Data source type: Administrative by-product data
Used for disaggregation by remoteness and SEIFA IRSD

Comments:

Most recent data available for 2015 National Healthcare Agreement (NHA) performance reporting: 2012–13.

The scope of the National Hospital Morbidity Database (NHMD) is episodes of care for admitted patients in essentially all hospitals in Australia, including public and private acute and psychiatric hospitals, free-standing day hospital facilities, alcohol and drug treatment hospitals and dental hospitals.

For 2011-12 data, the 2011 SEIFA IRSD quintile and decile data were produced using the Australian Standard Geography Classification geographical unit of Statistical Local Area. For 2012–13 data, the 2011 SEIFA IRSD quintile and decile data will be produced using the Australian Statistical Geography Standard geographical unit of Statistical Area 2.

The title of this indicator was changed in the 2012 NHISSC specifications from Unplanned/unexpected readmissions within 28 days of selected surgical admissions to Unplanned/unexpected readmissions within 28 days of selected surgical episodes of care to better reflect how the indicator is calculated. Readmissions for this indicator are defined within 28 days from the end of the patient’s surgical episode of care.

Representational attributes

Representation class:

Rate

Data type:

Real

Unit of measure:

Person

Format:

N[N].N

Indicator conceptual framework

Framework and dimensions:

Effectiveness

Safety

Accessibility

Data source attributes

Data sources:

Data Source

National Hospital Morbidity Database (NHMD)

Frequency

Annual

Data custodian

Australian Institute of Health and Welfare

Data Source

National Public Hospital Establishment Database (NPHED)

Frequency

Annual

Data custodian

Australian Institute of Health and Welfare

Accountability attributes

Reporting requirements:

National Healthcare Agreement

Organisation responsible for providing data:

Australian Institute of Health and Welfare

Further data development / collection required:

Specification: Substantial work required, the measure requires significant work to be undertaken.

Source and reference attributes

Relational attributes

Related metadata references:

National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2015

Identifying and definitional attributes

Collection and usage attributes

Representational attributes

Indicator conceptual framework

Data source attributes

Accountability attributes

Source and reference attributes

Relational attributes

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