DaPPHne (Diagnosing Potentially Preventable Hospitalisations)

This project is funded and supported by the Mid North Coast Local Health District, Agency for Clinical Innovation and Western Sydney Local Health District.

The project began in 2013 and was completed in January 2021.

NSW Health defined a number of unplanned hospital admissions as ‘preventable’, where healthcare in the community should/could have prevented the admission, for example an admission for a complication of diabetes which managed well in the community should not require a hospital admission.  There was a higher proportion of these admissions in rural areas of NSW.  The DaPPHne study aimed to determine the proportion of hospital admissions for older people with chronic conditions (chronic obstructive pulmonary disease, heart failure, diabetes complications and angina) that were deemed to be preventable and to identify potentially modifiable factors driving these admissions, to develop effective interventions to reduce admissions and improve measures of health system performance. The study built on previous UCRH research into understanding frequent hospital admissions of older people with chronic health conditions.

This was a mixed methods study in three hospitals in NSW. Data was collected from routine hospital records, an interview with the patient’s GP, an interview with the patient and senior clinicians involved in the patient’s hospital care. The data was presented for each participant as a case study and reviewed by a gold standard panel of experts to determine if that admission was preventable and why.

The key findings of this research included:

• 46% of the ‘potentially preventable hospitalisations’ (PPHs) were deemed to be preventable; 30% as not preventable and 24% as unclassifiable.
• Predictors of an admission being deemed to be preventable were study site, final principal diagnosis of congestive heart failure, a GP diagnosis of chronic obstructive pulmonary disease, fewer diagnoses on discharge, shorter hospital stay, a visit to the GP within the last 12 months and living alone.
• The validity of the PPH indicator (on which some of the funding to local health districts is dependent) is called into question.
• Opportunities to intervene to reduce PPHs include targeting older people with chronic obstructive pulmonary disease and congestive heart failure, the provision of social and welfare support for older people living alone and medication management.

The findings from this study were used to lobby for changes to the PPH indicator and were used to inform hospital and primary care policy and practice.