National Indigenous Reform Agreement: PI 03Hospitalisation rates by principal diagnosis, 2012
Identifying and definitional attributes  
Metadata item type:  Indicator 

Indicator type:  Indicator 
Short name:  PI 03Hospitalisation rates by principal diagnosis, 2012 
METeOR identifier:  438499 
Registration status:  Indigenous, Archived 13/06/2013 
Description:  Hospital separation rates for leading principal diagnoses for Australians, by Indigenous status. 
Rationale:  Monitoring hospitalisation rates for different diseases so that it is understood which diseases are major contributors to morbidity among Indigenous Australians and where programs are succeeding and where they are not will assist in achieving the closing the gap targets. 
Indicator set:  National Indigenous Reform Agreement (2012) Indigenous, Archived 13/06/2013 
Outcome area:  Indigenous Australians achieve health outcomes comparable to the broader population Indigenous, Endorsed 21/07/2010 
Quality statement:  National Indigenous Reform Agreement: PI 03Hospitalisation rates by principal diagnosis, 2012 QS Indigenous, Archived 13/06/2013 
Collection and usage attributes  
Computation description:  Crude rates are calculated for Indigenous Australians. Agestandardised rates are calculated for Indigenous and Other Australians. Rate ratios and rate differences are calculated for Indigenous:Other Australians. Principal diagnoses to be listed from highest to lowest Indigenous percentage for the most recent period (2 years combined). For variability bands: More work is to be undertaken by the AIHW regarding the use of variability bands for hospitalisation data for COAG reporting. For trends: Percentage change and statistical significance of change is to be calculated (required for CRC reporting). Presentation: Number, rate per 1,000 persons; percentage; rate ratios, rate differences. Excludes care types of:
Definitions: Other Australians includes nonIndigenous and ‘not stated’ Indigenous status. Leading principal diagnoses (ICD10AM codes) are those used in Aboriginal and Torres Strait Islander Health Performance Framework:

Computation:  Crude percentage: number of separations by principal diagnosis divided by total separations. Crude rate: 1,000 x (Numerator ÷ Denominator). Agestandardised rate: calculated using the direct method using five year age groups from 04 to 65 years and over (due to availability of Indigenous population estimates for Tas and ACT) and the Australian population as at 30 June 2001 as the standard. Agestandardisation should be done in accordance with the NIRAPIMG agreed principles for direct agestandardisation (see Comments section). Rate ratio: Indigenous agestandardised rate divided by Other Australian agestandardised rate. Rate difference: Indigenous age standardised rate minus Other Australian agestandardised rate. Percentage change: Calculated by multiplying the average annual change over the period by the number of data points less 1. This is then divided by the rate for the first year in the series and multiplied by 100. The average annual change in rates, rate ratios and rate differences are calculated using linear regression which uses the least squares method to calculate a straight line that best fits the data and returns an array that best describes the line. The simple linear regression line, Y = a + bX, or ‘slope’ estimate was used to determine the average annual change in the data over the period. The formula used to calculate the slope estimate and standard error of the slope in Microsoft Excel is: LINEST (known_y’s, known_x’s, true) entered as an array formula (Ctrl, Shift, Enter). Statistical significance of change: More work to be undertaken by the AIHW regarding the use and methodology for statistical significance of change for hospitalisation data. 
Numerator:  Number of hospital separations (public and private). 
Numerator data elements:  
Denominator:  Total population of all people. 
Denominator data elements:  
Disaggregation:  Current period  200809 to 200910: For Indigenous only (crude rates, and percentage).
For Indigenous and other Australians (age standardised rates, rate ratios, and rate differences).
Time series – 200607, 200708, 200809 (previously supplied), 200910 (to be supplied for 2012 reporting): For Indigenous and other Australians (age standardised rates, rate ratios, rate differences, and percent change. Variability bands and statistical significance of change to be advised by AIHW).

Disaggregation data elements:  
Comments:  Most recent data available for 2012 CRC report is 200910. Aggregated data (200809 to 200910) will be used for the current reporting period. Single year data (200607, 200708, 200809 and 200910) will be used for time series analysis; noting that previously supplied data will be used unless a resupply is provided. National disaggregation by Indigenous status will be based on data only from jurisdictions for which the quality of Indigenous identification is considered acceptable. At this stage, only data from selected state/territories are considered of acceptable quality for reporting hospitalisations of Indigenous persons: NSW, Vic, Qld, WA, SA and NT public hospitals. National rates should include these six states and territories only. Tas/ACT data should be reported separately with caveats. Disaggregation by state/territory is based on the state/territory of the usual residence of the patient. National estimates adjusted for underidentification will be reported for total hospitalisations only as adjustment by cause is not possible. Disaggregation by Indigenous status is to be reported using 2 years combined data for the current reporting period. Single year data is to be reported for time series. To report trends, the COAG Reform Council will separately request percentage change and statistical significance testing for this indicator directly from the data provider (AIHW). More work is to be undertaken by the AIHW regarding the use of variability bands for hospitalisation data for COAG reporting. Baseline year for NIRA target (Close the life expectancy gap within a generation) is 2006; baseline year for this indicator is 200607; target year is 2031. NIRAPIMG agreed principles for reporting directly agestandardised rates for administrative data. Overarching principle: Before undertaking agestandardisation, analysts must investigate the data being used to understand the agespecific distribution and any limitations that may impact on the results. Principle 1: The standard population used should be the Australian Estimated Resident Population as at 30 June 2001 from the 2001 Census until population estimates from the 2011 Census become available. The population used as the denominator for the calculation of Indigenous agestandardised rates should be SERIES B of Indigenous experimental estimates and projections 2006 to 2021 based on the 2006 Census until population estimates from the 2011 Census become available. Principle 2: If the denominator is less than 30 in any one age group, then do not attempt to produce agestandardised rates. Agegroups may be collapsed to obtain a denominator of 30 or more (provided that this is in accordance with Principle 3 and 4). Principle 3: If the total number of Indigenous events (e.g. deaths, hospital separations) is less than 20, then do not attempt to produce agestandardised rates. Combining several years of data, or aggregating jurisdictions should be considered to obtain a total of 20 or more events. If this does not meet the purpose (i.e. data are required for time series or jurisdictional comparisons), or does not result in greater than 20 events in total, then other measures and contextual information should be reported instead of agestandardised rates which could include total number of events, crude rates, agespecific rates, agespecific rate ratios and median age at death. Principle 4: Agestandardised rates should be calculated using the five year age groupings of 04 to 75+ (provided Principles 2 and 3 for denominator and numerator are met). 10year age groups may be used to overcome small numbers (20 year age groups are too wide and should not be used). Principle 5: Additional contextual information (most importantly agespecific rates and ratios) should be provided in addition to agestandardised rates when: a) the agestandardised rates and rate ratios lie largely outside the range of the agespecific rates and rate ratios. b) the pattern of agespecific rates of the Indigenous and nonIndigenous populations differ substantially (e.g. deaths from a certain cause concentrate on younger ages for Indigenous population while for nonIndigenous they may occur at older ages). c) the agespecific rates depart from the assumption of a uniform increase in death with age (e.g. injury which peaks in the young adult to middleages and certain cancers amenable to treatment for some age groups). d) the condition of interest is largely confined to a specific age range (e.g. STIs and women who give birth). In such instances, agestandardisation could be restricted to include the age groups within this age range only. Principle 6: For conditions restricted to a specific age group (e.g. conditions originating in the perinatal period and SIDS), it is recommended to report the agespecific rate for the agegroup of interest instead of the agestandardised rate. 
Representational attributes  
Representation class:  Rate 
Data type:  Real 
Unit of measure:  Person 
Format:  N[NN].N 
Indicator conceptual framework  
Framework and dimensions:  Health Conditions 
Data source attributes  
Data sources:  
Accountability attributes  
Reporting requirements:  National Indigenous Reform Agreement. 
Organisation responsible for providing data:  Australian Institute of Health and Welfare. 
Further data development / collection required:  Specification: Longterm. Improve the quality of Indigenous identification in hospital data. 
Source and reference attributes  
Steward:  National Indigenous Reform Agreement Performance Information Management Group 
Relational attributes  
Related metadata references:  See also National Healthcare Agreement: PI 22Selected potentially preventable hospitalisations, 2012 Health, Superseded 25/06/2013 See also National Healthcare Agreement: PI 62Hospitalisation for injury and poisoning, 2012 Health, Retired 25/06/2013 Supersedes National Indigenous Reform Agreement: PI 03Hospitalisation rates by principal diagnosis, 2011 Indigenous, Archived 01/07/2012 
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