ACSC 04-05 Barwon South West

ACSC 2004-2005 Update Barwon-South Western Region (Including Primary Care Partnerships and Local Government Areas)

Victorian Ambulatory Care Sensitive Conditions Study Ambulatory care sensitive conditions (ACSCs) are those for which hospitalisation is thought to be avoidable if preventive care and Figure 1: ACSCs Admission Rates, Barwon-South Western early disease management are applied, usually in an ambulatory Region, 1995–96 to 2004–05 setting1. In theory, access to timely and effective ambulatory care 50 can reduce the risks of hospitalisation. 40 The Victorian Ambulatory Sensitive Conditions Study is updated annually by the Chronic Disease Surveillance and Epidemiology 30 Section of the Department of Human Services (DHS). This fact sheet presents analyses of ACSCs for the DHS Barwon 20 South-Western Region as a whole and for the primary care partnerships and local government areas in this region, using the 10 Victorian Admitted Episodes Dataset (VAED) from 1995-96 to Population 1000 Rate per 2004-05. Rates of admission were age- and sex-standardised to 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 the Victorian population (1996) using the direct method. –96 –97 –98 –99 -2000 –01 –02 –03 –04 –05

Barwon-South Western Region Figure 2: Total ACSCs Admission Rate Ratios, Barwon-South The Barwon-South Western Region covers an area of 29,637 Western Region (Victoria = 1), 1995–96 to 2004–05 square kilometres. It covers the southwest of the state from 1.2 Queenscliffe in the east to the far southwest border with South Australia. It had an estimated population of 350,801 in 2004. 1.1 The region includes three Primary Care Partnerships (PCPs) and o nine Local Government Areas (LGAs). i 1.0 Variations in Rates of ACSCs Admission, 1995–96 to 2004–05 Rate Rat There were 16,558 admissions for total ACSCs in 2004–05, 0.9 with an average of 5.08 bed days. The admission rate for total

ACSCs increased from 25.26 per 1,000 persons (24.73–25.80) 0.8 in 1995–96 to 38.46 per 1,000 persons (37.48–39.47) in 2004– 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 (Figure 1). The increase between 2003–04 and 2004–05 –96 –97 –98 –99 –2000 –01 –02 –03 –04 –05 may be due, in part, to a change in coding practices for diabetes complications2. Contents Barwon–South Western Region 1 Variations in Rates of ACSCs Admission, 1995–96 to Southern Grampians/Glenelg Primary Care Partnership 3 2004–05 • Glenelg 4 Barwon-South Western region’s admission rate ratios for total • Southern Grampians 4 ACSCs have declined relative to Victorian averages between South West Primary Care Partnership 5 1995–96 and 2004–05 (Figure 2). In 2004–05 the region’s • Corangamite 6 admission rate ratios were below the Victorian average. • Moyne 6 • Warrnambool 6 Barwon Primary Care Partnership 7 • Colac–Otway 8 • Greater Geelong 8 1 Billings J, Zeitel L, Lukomnik J, Carey T, Blank A, Newman L. Impact of socioeconomic status • Queenscliffe 8 on hospital use in New York City. Health Affairs, 1993, 12, 162173. 2 From 1 July 2004, changes to Australian Coding Standard 0401 Diabetes mellitus and • Surf Coast 8 impaired glucose regulation impacted on ICD-10-AM diagnosis coding with respect to three codes relevant to diabetic complications ACSCs viz. E11.72, E12.72 and E13.72. These codes refer to diabetes mellitus (except Type 1) with hypertension and/or other factors (including obesity, insulin resistance, acanthosis nigricans, dyslipidaemia etc.). The higher number of admissions for diabetes complications may, in part, reﬂ ect this change (See Appendix for further details). 1 Top 10 Individual ACSCs Admissions, (Victoria = 1), 2004–05 Table 1 summarises the admission rates and average bed days for the top 10 ACSCs in 2004–05. In addition to chronic ACSCs (diabetes complications and chronic obstructive pulmonary disease), the top ﬁ ve ACSCs admissions also included dental conditions, dehydration and gastroenteritis and pyelonephritis. The top 10 ACSCs accounted for 90.02 per cent of the total ACSCs admission in the region. The average bed days for the top 10 ACSCs was 5.10 in 2004–05.

Table 1: Top 10 ACSCs in Region 1—Barwon-South Western Region, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 7,161 16.49 16.11 16.88 6.31 45,205 Dental conditions 1,140 3.28 3.10 3.48 1.13 1,291 COPD 1,124 2.43 2.29 2.57 7.68 8,627 Dehydration and gastroenteritis 883 2.35 2.20 2.51 2.33 2,057 Pyelonephritis 859 2.13 1.99 2.28 5.00 4,298 Angina 959 2.11 1.98 2.25 2.67 2,556 Ear, nose and throat infections 657 2.03 1.88 2.19 1.75 1,147 Asthma 674 1.97 1.82 2.12 2.45 1,648 Congestive cardiac failure 909 1.84 1.73 1.97 8.49 7,719 Convulsions and epilepsy 540 1.60 1.47 1.74 2.69 1,451

Note: CI = confi dence interval. Admission Rate Ratios for Top 10 ACSCs, Barwon-South Western Region, (Victoria = 1), 2004–05 Key Findings— Compared with the Victorian average, the region’s admission Barwon-South Western Region rate ratios were signifi cantly lower for diabetes complications, • Admission rates for ACSCs increased in the region over the chronic obstructive pulmonary disease (COPD), dehydration ten-year period. and gastroenteritis, pyelonephritis and congestive cardiac • In addition to including chronic conditions, the top 5 failure (Figure 3). The region’s admission rate ratios for diabetes ACSCs also included dental conditions dehydration and complications, COPD, dehydration and gastroenteritis, gastroenteritis, and pyelonephritis. pyelonephritis and congestive heart failure were signifi cantly lower • The region’s admission rate ratios for diabetes than the Victorian averages in 2004–05. Ear, nose and throat complications, COPD, dehydration and gastroenteritis, infections accounted for the region’s highest admission rate ratio, pyelonephritis and congestive heart failure were which was 1.44 (1.32–1.55). signifi cantly lower than the Victorian averages in 2004–05. • The region’s admission rate ratios for dental conditions and Figure 3: Top 10 ACSCs Admission Rate Ratios for Barwon-South ear, nose and throat infections were signifi cantly higher Western Region, (Victoria = 1), 2004–05 than the Victorian averages. 1.6

1.4 o i 1.2

Rate rat 1.0

0.8

0.6

ns COPD Dental Angina Asthma Diabetes ation and conditions troenteritis Congestive Convulsions and epilepsy complications gas Pyelonephritis ENT infectio cardiac failure Dehydr

2 PCP1PCP1 Southern Grampians/Glenelg Primary Care Partnership (PCP 1)

Variations in Rates of ACSCs Admission, 2000–01 to Admission Rate Ratios for the Top 10 Individual ACSCs, 2004–05 (Victoria = 1), 2004–05 The Primary Care Partnership’s (PCP) admission rates for total The PCP’s admission rate ratios for fi ve of the top 10 ACSCs ACSCs increased over the fi ve-year period. The admission rates (diabetes complications, dehydration and gastroenteritis, asthma, for total ACSCs increased from 38.45 per 1,000 persons (36.64– convulsions and epilepsy, and ear, nose and throat infections) 40.34) in 2000–01 to 55.29 per 1,000 persons (53.16–57.51) in were signifi cantly higher than the Victorian averages in 2004–05 2004–05 (Figure 4). (Figure 5). The PCP’s highest admission rate ratio was for diabetes complications, which was 1.52 (1.44–1.58). Figure 4: ACSCs Admission Rates in Southern Grampians/ Glenelg PCP, 2000–01 to 2004–05 Figure 5: Top 10 ACSC Admission Rate Ratios in Southern 60 Grampians/Glenelg PCP, (Victoria = 1), 2004–05

2.0 50

1.5 30

20 Rate ratio 1.0

Rate per 1000 Population Population 1000 Rate per 10

0 2000–01 2001–02 2002–03 2003–04 2004–05 0.5

tive ons COPD Dental Asthma Angina Diabetes Top 10 Individual ACSCs Admissions, 2004–05 conditions Conges Convulsi heart failure and epilepsyEar, nose and complicationsgastroenteritis Pyelonephritis Table 2 summarises the admission rates and average bed days for Dehydration and throat infections the top 10 ACSCs in 2004–05. Diabetes complications was the leading cause of ACSCs admissions for the PCP in 2004–05. The top 10 ACSCs admissions accounted for 93.11 per cent of the total ACSCs admissions in the region. The average bed days for the top 10 ACSCs admissions was 3.82 in 2004–05.

Table 2: Top 10 ACSCs in PCP1 —Southern Grampians/Glenelg, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 1,453 30.28 28.77 31.88 3.60 5,227 Dehydration and gastroenteritis 126 3.25 2.73 3.88 2.23 281 Dental conditions 117 3.20 2.67 3.83 1.20 140 COPD 146 2.83 2.41 3.33 6.36 928 Asthma 88 2.40 1.95 2.95 2.61 230 Congestive heart failure 135 2.39 2.02 2.83 9.53 1,287 Convulsions and epilepsy 75 2.24 1.79 2.81 2.23 167 Ear, nose and throat infections 69 2.06 1.62 2.60 2.28 157 Angina 104 2.03 1.68 2.46 3.12 324 Pyelonephritis 78 1.94 1.55 2.42 4.90 382

Note: CI = conﬁ dence interval.

3 Top 5 Individual ACSCs Admissions for Local Government Areas in the Southern Grampians/Glenelg PCP, 2004–05 The Southern Grampians/Glenelg PCP includes two local government areas (LGAs), Glenelg and Southern Grampians. In these LGAs diabetes complications were the leading cause of ACSCs admissions in 2004–05 (Tables 3 and 4)

Table 3: Top 5 ACSCs in the Glenelg LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 1,080 44.32 41.76 47.05 2.83 3,053 Dehydration and gastroenteritis 82 3.88 3.12 4.81 2.33 191 Asthma 55 2.67 2.05 3.48 2.49 137 Congestive heart failure 73 2.62 2.08 3.29 9.41 687 Ear, nose and throat infections 47 2.60 1.95 3.46 2.40 113

Note: CI = confi dence interval. The top fi ve ACSCs admissions accounted for 80.06 per cent of the total ACSCs admissions in the LGA. The average bed days for the top fi ve ACSCs admissions in Glenelg was 3.13 in 2004–05.

Table 4: Top 5 ACSCs in the Southern Grampians LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 373 14.77 13.35 16.35 5.83 2,174 Dental conditions 69 4.39 3.47 5.56 1.06 73 COPD 96 3.79 3.11 4.63 6.66 639 Convulsions and epilepsy 37 2.60 1.88 3.58 1.86 69 Dehydration and gastroenteritis 44 2.54 1.89 3.41 2.05 90

Note: CI = confi dence interval. The top fi ve ACSCs admissions accounted for 68.9 per cent of the total ACSCs admissions in the LGA. The average bed days for the top fi ve ACSCs admissions in Southern Grampians was 4.92 in 2004–05.

Key Findings— PCP1—Southern Grampians/Glenelg • The PCP’s admission rates for total ACSCs increased over the fi ve-year period. • The PCP’s admission rate ratios for fi ve of the top 10 ACSCs (diabetes complications, dehydration and gastroenteritis, asthma, convulsions and epilepsy, and ear, nose and throat infections) were signifi cantly higher than the Victorian averages in 2004–05. • The PCP’s highest admission rate ratio was for diabetes complications, which was 1.52 (1.44–1.58).

4 South West Primary Care Partnership PCP2 (PCP2)

Variations in Rates of ACSCs Admission, 2000–01 to Admission Rate Ratios for the Top 10 Individual ACSCs, 2004–05 (Victoria = 1), 2004–05 The Primary Care Partnership’s (PCP) admission rates for total The PCP’s admission rate ratios for the top 10 ACSCs (except ACSCs have increased over the ﬁ ve-year period. The admission diabetes complications, dental conditions, congestive heart failure rates for total ACSCs were 42.50 per 1,000 persons (40.99– and pyelonephritis) were signiﬁ cantly higher than the Victorian 44.07) in 2000–01 and 46.24 per 1,000 persons (47.83–44.71) in averages in 2004–05 (Figure 7). The PCP’s highest admission 2004–05 (Figure 6). rate ratio was for ear, nose and throat infections, which was 1.82 (1.55–2.14). Figure 6: ACSCs Admission Rates in South West PCP, 2000–01 to 2004–05 Figure 7: Top 10 ACSC Admission Rate Ratios in South West PCP, 60 (Victoria = 1), 2004–05 2.5 50 on i

40 2.0 o 30 i

1.5 20 Rate rat

Rate per 1000 Populat 1000 Rate per 10 1.0

0 2000–01 2001–02 2002–03 2003–04 2004–05 0.5

is Top 10 Individual ACSCs Admissions, 2004–05 tive tis COPD Angina Diabetes Asthma nephri Cellulit Table 5 summarises the admission rates and average bed days conditionsConges Dehydration Ear, nose and heart failure complications Pyelo for the top 10 ACSCs in 2004–05. Diabetes complications was throat infections and gastroenteritis Dental the PCP’s leading cause of ACSCs admissions in 2004–05. The top 10 ACSCs accounted for 89.66 per cent of the total ACSCs admissions in the region. The average bed days for the top 10 ACSCs admissions was 5.40 in 2004–05.

Table 5: Top 10 ACSCs in PCP2—Southern West, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 1,427 18.82 17.87 19.83 6.50 9,275 Dehydration and gastroenteritis 246 3.68 3.25 4.17 2.28 562 COPD 289 3.55 3.17 3.99 7.56 2,186 Angina 225 2.81 2.46 3.20 2.87 645 Asthma 168 2.59 2.23 3.01 2.44 410 Ear, nose and throat infections 151 2.57 2.19 3.01 1.67 252 Dental conditions 161 2.54 2.17 2.96 1.14 183 Congestive heart failure 212 2.43 2.13 2.79 9.46 2,006 Pyelonephritis 156 2.16 1.85 2.53 5.15 803 Cellulitis 146 2.04 1.73 2.40 5.95 869

Note: CI = conﬁ dence interval.

5 Top 5 Individual ACSCs Admissions for Local Government Areas in the South West PCP, 2004–05 The South West PCP includes three local government areas (LGAs), Corangamite, Moyne and Warrnambool. In these LGAs diabetes complications were the leading cause of ACSCs admissions in 2004–05 (Tables 6–8). The top ﬁ ve ACSCs admissions accounted for 67.94 per cent, 62.14 per cent and 68.76 per cent of total ACSCs admissions, respectively.

Table 6: Top 5 ACSCs in the Corangamite LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 335 14.50 13.02 16.14 7.11 2,383 Dehydration and gastroenteritis 88 4.96 4.02 6.11 2.00 176 COPD 90 3.64 2.96 4.48 7.47 672 Angina 74 3.16 2.51 3.96 2.62 194 Asthma 55 3.08 2.36 4.01 2.67 147

Note: CI = conﬁ dence interval.

Table 7: Top 5 ACSCs in the Moyne LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 234 12.25 10.78 13.93 6.71 1,571 Dehydration and gastroenteritis 46 2.71 2.03 3.62 2.59 119 Congestive heart failure 49 2.48 1.87 3.28 7.22 354 COPD 52 2.42 1.85 3.18 7.35 382 Ear, nose and throat infections 31 2.22 1.56 3.16 1.58 49

Note: CI = conﬁ dence interval.

Table 8: Top 5 ACSCs in the Warrnambool LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 858 25.33 23.69 27.08 6.20 5,321 COPD 147 4.05 3.45 4.76 7.70 1,132 Dehydration and gastroenteritis 112 3.50 2.91 4.21 2.38 267 Angina 120 3.28 2.75 3.93 3.08 370 Pyelonephritis 97 2.91 2.39 3.55 4.55 441

Note: CI = conﬁ dence interval.

Key Findings– PCP2—South West • The Primary Care Partnership’s (PCP) admission rates for total ACSCs have increased slightly over the ﬁ ve-year period. • The PCP’s admission rate ratios for the top 10 ACSCs (except diabetes complications, dental conditions, congestive heart failure and pyelonephritis) were signiﬁ cantly higher than the Victorian averages in 2004–05. • The PCP’s highest admission rate ratio was for ear, nose and throat infections, which was 1.82 (1.55–2.14).

6 PCP3 Barwon Primary Care Partnership (PCP 3)

Variations in Rates of ACSCs Admission, 2000–01 to Admission Rate Ratios for the Top 10 Individual ACSCs, 2004–05 (Victoria = 1), 2004–05 The Primary Care Partnership’s (PCP) admission rates for total The PCP’s admission rate ratios for dental conditions, and ear, ACSCs increased over the ﬁ ve-year period. The PCP’s admission nose and throat infections were signiﬁ cantly higher than the rates for total ACSCs increased from 27.73 per 1,000 persons Victorian averages in 2004–05. The PCP’s highest admission (27.10–28.39) in 2000–01 to 33.97 (33.31–34.65) per 1,000 rate ratio was for ear, nose and throat infections, which was 1.35 persons in 2004–05 (Figure 8). (1.22–1.48).

Figure 8: ACSCs Admission Rates in Barwon PCP, 2000–01 to Figure 9: Top 10 ACSC Admission Rate Ratios in Barwon PCP, 2004–05 (Victoria = 1), 2004–05 60 1.6

on 1.4 i

40 o i 1.2 30

Rate rat 1.0 20

0.8 Rate per 1000 Populat 1000 Rate per 10

0 0.6 2000–01 2001–02 2002–03 2003–04 2004–05 s

COPD n and Angina Asthma Diabetes atio infections Top 10 Individual ACSCs Admissions, 2004–05 Congestive Convulsions Ear, nose and heart failure and epilepsy complications Pyelonephriti gastroenteritis Table 9 summarises the admission rates and average bed days Dental conditions throat Dehydr for the top 10 ACSCs in 2004–2005. Diabetes complications was the leading cause of ACSCs admissions for the PCP in 2004–05. The top 10 ACSCs admissions accounted for 89.84 per cent of the total ACSCs admissions in the region. The average bed days for the top 10 ACSCs admissions was 5.36 in 2004–05.

Table 9: Top 10 ACSCs in PCP1—Barwon, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 4,281 13.73 13.32 14.15 7.17 30,703 Dental conditions 862 3.49 3.26 3.73 1.12 968 Pyelonephritis 625 2.16 2.00 2.34 4.98 3,113 COPD 689 2.08 1.93 2.25 8.00 5,513 Angina 630 1.96 1.81 2.11 2.52 1,587 Ear, nose and throat infections 437 1.90 1.73 2.09 1.69 738 Dehydration and gastroenteritis 511 1.90 1.74 2.07 2.38 1,214 Asthma 418 1.73 1.57 1.91 2.41 1,008 Congestive heart failure 562 1.61 1.48 1.75 7.88 4,426 Convulsions and epilepsy 366 1.50 1.35 1.66 2.87 1,052

Note: CI = conﬁ dence interval.

7 Top 5 Individual ACSCs Admissions for Local Government Areas in the Barwon PCP, 2004–05 The Barwon PCP includes four local government areas (LGAs), Colac-Otway, Greater Geelong, Queenscliffe and Surf Coast. In these LGAs, diabetes complications were the leading cause of ACSCs admissions, in 2004–05 (Tables 10–13). The top ﬁ ve ACSCs accounted for 65.51 per cent, 68.46 per cent, 62.94 per cent and 66.62 per cent, respectively.

Table 10: Top 5 ACSCs in the Colac-Otway LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 286 10.03 8.93 11.26 7.01 2,004 Dental conditions 148 7.27 6.19 8.54 1.16 172 Dehydration and gastroenteritis 66 2.86 2.25 3.64 2.92 193 Pyelonephritis 57 2.27 1.75 2.95 4.63 264 Angina 66 2.17 1.71 2.77 3.05 201

Note: CI = conﬁ dence interval.

Table 11: Top 5 ACSCs in the Greater Geelong LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 3,741 14.91 14.44 15.40 7.19 26,894 Dental conditions 595 3.02 2.78 3.27 1.12 667 Pyelonephritis 525 2.24 2.06 2.44 5.03 2,639 COPD 580 2.17 2.00 2.36 8.24 4,780 Angina 516 1.99 1.83 2.17 2.51 1,295

Note: CI = conﬁ dence interval.

Table 12: Top 5 ACSCs in the Queenscliffe LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 53 7.38 5.64 9.67 5.87 311 Dental conditions 12 4.34 2.46 7.64 1.00 12 Ear, nose and throat infections 7 4.13 1.97 8.66 1.29 9 Convulsions and epilepsy 5 1.82 0.76 4.38 1.80 9 Angina 13 1.80 1.04 3.10 2.62 34

Note: CI = conﬁ dence interval.

Table 13: Top 5 ACSCs in the Surf Coast LGA, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 201 8.05 7.01 9.24 7.43 1,494 Dental conditions 107 4.38 3.62 5.29 1.09 117 Dehydration and gastroenteritis 46 2.00 1.50 2.67 2.26 104 Ear, nose and throat infections 35 1.70 1.22 2.37 1.31 46 COPD 42 1.66 1.23 2.25 7.38 310

Note: CI = conﬁ dence interval.

Key Findings—PCP3—Barwon • The PCP’s admission rates for total ACSCs increased over the ﬁ ve-year period. • The PCP’s admission rate ratios for the top 10 ACSCs were signiﬁ cantly higher than the Victorian averages for dental conditions and ear, nose and throat infections in 2004–05. • The PCP’s highest admission rate ratio was for ear, nose and throat infections, which was 1.35 (1.22–1.48).

8 Suggested Citation: Appendix—Impact of the change in coding practice Chronic Disease Surveillance & Epidemiology Section, Public From 1 July 2004, changes to Australian Coding Standard 0401 Health, Department of Human Services (2006). Ambulatory Diabetes mellitus and impaired glucose regulation impacted care sensitive conditions 2004–05 update: Barwon-South on ICD-10-AM diagnosis coding with respect to three codes Western Region (including Primary Care Partnerships and Local relevant to diabetic complications ACSCs viz. E11.72, E12.72 Government Areas). Melbourne, Victoria: Victorian Government. and E13.72. These codes refer to diabetes mellitus (except Type Additional Information 1) with hypertension and/or other factors (including obesity, Full details of the methodology are available from earlier insulin resistance, acanthosis nigricans, dyslipidaemia etc.). ACSC reports which can be downloaded from the Department The higher number of admissions for diabetes complications of Human Services website at: may, in part, reﬂ ect this change. http://www.health.vic.gov.au/healthstatus/acsc/index.htm The number of ACSCs admissions for Victoria increased from Contact Details: 174,821 in 2003–04 to 209,183 in 2004–05 (up by about a Dr. Zahid Ansari quarter). This increase is entirely due to an increase of about Manager, Chronic Disease Surveillance, 80 percent in diabetes complications, from 55,803 admissions Chronic Disease Surveillance & Epidemiology Section in 2003–04 to 99,317 admissions in 2004–05. In fact, when Email: [email protected] diabetes complications are excluded, ACSCs admissions actually decreased slightly from 112,348 in 2003–04 to 109,866 in 2004–05. The increase in diabetes complications may be due, in part, to the change in coding practice effective from July 1, 2004 related to ICD-10-AM codes E11.72, E13.72 and E14.72. After statistical analysis, we estimate that for Victoria as a whole, about three quarters of the increase in total ACSCs is due to the changed coding practice, and about one quarter would have occurred anyway. This means that when comparing ACSCs admission rates for 2003–04 and 2004–05, a good rule of thumb is to discount by three quarters the observed increase in diabetes complications. When applied to the observed increase of about a quarter for total ACSCs admissions, this implies that the real increase (apart from coding issues) is about 5 per cent. July 2006 ACSC 2004-2005 UPDATE