AREAS TO ACT: A SOUTH AUSTRALIAN REVIEW OF POTENTIALLY PREVENTABLE ADMISSIONS

sahealth.sa.gov.au CONTENTS

Executive Summary...... 3 5. Results...... 10 5.1 Aggregate (overall) hotspots...... 10 1. Foreword...... 5 5.2 Group level hotspots ...... 13 2. Background...... 5 5.2.1 Acute conditions hotspots...... 13 5.2.2 Chronic conditions hotspots...... 15 3. Context...... 6 5.2.3 Vaccine-preventable conditions hotspots...... 17 3.1 Department for Health and Wellbeing...... 6 5.3 Specific PPA conditions...... 19 3.2 The Health Performance Council...... 6 5.3.1 Top 10 PPA conditions in SA...... 19 5.3.1.1 Chronic obstructive pulmonary 3.3 The Adelaide and Country SA disease (COPD)...... 20 PHNs...... 6 5.3.1.2 Convulsions and epilepsy...... 22 5.3.1.3 Diabetes complications...... 24 4. Definitions...... 7 5.3.1.4 Angina...... 26 4.1 What is a PPA?...... 7 5.3.1.5 Other vaccine-preventable conditions.. 28 4.2 Rate multiple...... 9 5.3.1.6 Asthma...... 30 5.3.1.7 Congestive cardiac failure...... 32 4.3 What is a hotspot?...... 9 5.3.1.8 Dental conditions...... 34 5.3.1.9 Ear, nose and throat infections...... 36 5.3.1.10 Cellulitis...... 38 5.4 Top 15 hot SA2s...... 40

6. Key messages and potential future work...... 42

7. Limitations of this report...... 42

8. Appendices...... 43 8.1 Qualifying and excluded PPA conditions...... 43 8.2 Areas excluded from analysis...... 43 8.3 Reference map and area key...... 44

9. Reference List...... 47 EXECUTIVE SUMMARY

Population health is determined via both social determinants of health and health service proximity, whereby outcomes and opportunities are shaped by location (place).

There are also a range of other determinants of health, including environmental, biological and economic factors which are linked to place and health differences. Where the role of place in shaping people’s health and opportunity is well established, there is only limited evidence for what works in reducing place-based health inequalities (Duckett & Griffiths, 2016). To expand upon the limited evidence regarding what works in reducing place-based health problems, South Australian (SA) Department for Health and Wellbeing (DHW) has collaborated with the Primary Health Networks (PHNs) to identify these needs by place. The SA PHNs have also included place- based prioritisation as part of their Needs Assessments for commissioning services within each of their regions. The South Australian Areas to Act report is the first step in building the evidence base to identify the areas in SA where health inequalities are entrenched and without intervention, are likely to continue.

Data analysis is informed by the following: > A Statistical Area Level 2 (SA2) was identified as a hotspot if its Potentially Preventable Admission (PPA) rate was at least 1.5 times above the state average in three consecutive years in the reporting period (2014 – 2018). > Analysis is based on Adelaide PHN (Metropolitan) and Country SA PHN (Country SA) SA2 boundaries. > Analysis excludes SA2s with a population less than 1,000 persons in any year from 2004 to 2018. > Analysis excludes PPA condition with less than 10 hospital admissions for a particular year. > Analysis includes PPAs from all public and private hospitals in SA.

Areas to Act: A South Australian Review of Potentially Preventable Admissions 3 Areas of greatest need: The greatest need in terms of PPA > Findings on overall PPAs from 2004 to 2018 indicate that conditions occurs in the SA2s listed below. six of the twelve identified hotspot SA2s have persisted Metropolitan for all 15 years. > Elizabeth − Elizabeth − Port Pirie > Smithfield - Elizabeth North − Ceduna > Christie Downs − Port Augusta > Davoren Park − Berri > Salisbury North − Renmark > Salisbury > The Coorong was hot for 14 years. > Port Adelaide > The following SA2s were hot for 13 years. > Hackham - Onkaparinga Hills − Davoren Park − Christie Downs Country SA − Hackham West - Huntfield Heights > Port Augusta > Smithfield - Elizabeth North and Millicent were hot for > Renmark 11 years. > Millicent Areas of greatest need when examined > Port Pirie as either an acute, chronic, or vaccine- > Ceduna preventable condition: > The Coorong > Elizabeth, Smithfield - Elizabeth North and Port Augusta > Berri qualified as a hotspot for acute, chronic and vaccine- preventable conditions. It may be difficult to readily measure changes in rates for > Port Pirie, Millicent, Berri, Renmark and The Coorong categories of PPA that can be attributed to the effects or qualified as a hotspot for acute and chronic conditions. mitigation measures of different sections in the health sector. PPAs are only one measure of potentially preventable > Davoren Park, Salisbury, Salisbury North, Christie Downs admissions and exclude hospitalisations for injury and and Port Adelaide qualified as a hotspot for chronic and poisoning that may also be considered potentially avoidable vaccine-preventable conditions. (Commonwealth Department of Health, 2018). Therefore, it is important that DHW, the Local Health Networks (LHNs) and Based on the number of hotspots identified the PHNs continue to work collaboratively to investigate local for each PPA condition, the top 10 PPA factors and variables affecting hotspots in order to develop conditions in SA were: joint mitigation measures. > Chronic Obstructive Pulmonary Disorder (COPD); > Convulsions and epilepsy; > Diabetes complications; > Angina; > Other vaccine-preventable conditions; > Asthma; > Congestive Cardiac Failure (CCF); > Dental conditions; > Ear, nose and throat (ENT) infections; and > Cellulitis.

4 Areas to Act: A South Australian Review of Potentially Preventable Admissions 1. FOREWORD 2. BACKGROUND

This report summarises the purpose, methodology, On 24 July 2016, the Grattan Institute published the report and findings of a collaborative project between the SA Perils of Place: identifying hotspots of health inequality. The Department for Health and Wellbeing (DHW), the Health report identified and detailed a number of ‘priority places’ Performance Council (HPC), Adelaide PHN, and Country SA with consistently high rates of hospitalisations for PPAs across PHN. the states of Victoria and Queensland. ‘Hotspots’ are small areas with a consistent, and The objectives of this report are to: comparatively high rate of hospitalisation for a particular > Identify and profile geographical hotspots of persistent health problem compared to the larger region. Areas were PPAs across SA. identified as hotspots if they were sufficiently hot enough (a rate of at least 50% above the state average), persistently > Help inform primary health care and inpatient service hot (hot for a specified number of years) and therefore planning by both the PHNs and LHNs in which the DHW considered likely to stay hot. The methodology used in this and the HPC have an interest from an operational, report followed the Grattan Institute’s Perils of Place report budgetary, and public interest perspective. (Duckett & Griffiths, 2016), unless described otherwise. > Strengthen joint planning relationships through Potentially preventable hospital admission rates have experience and improved skills in analysing routinely been used in the National Healthcare Agreement (2012), collected administrative data. the National Health Performance Framework (2009), the Aboriginal and Torres Strait Islander Health Performance Presented within this report is the summary of findings from Framework (2006), and the PHN Program Performance and an analysis of PPAs for the SA population from hospital data Quality Framework (2018) as one indicator of health system for the 2004 to 2018 period. performance, specifically the accessibility and effectiveness of local health services. As reported by Duckett & Griffiths (2016) PPA rates are also an indicator of serious, but reducible health inequality.

Areas to Act: A South Australian Review of Potentially Preventable Admissions 5 3. CONTEXT

In November 2019, HPC published an in-brief report based 3.2 The Health Performance Council on some high level analysis on SA public hospital admissions data to reveal areas of the state, mainly in regional and The HPC is a statutory body established under the Health remote country areas, which had particularly and persistently Care Act 2008 to provide expert advice to the Minister for high levels of PPAs (Health Performance Council, 2019). Health and Wellbeing on: A detailed geographical analysis of PPAs across SA using > the performance of the health system the Grattan Institute methodology has not previously been > health outcomes for SA, including specific population undertaken. With this report for South Australia, the DHW, groups HPC, Adelaide PHN, and Country SA PHN have a resource for consideration when setting local health priorities. Any > the effectiveness of community and individual response to the results of this report should consider the engagement. extent to which each health problem is preventable, if an The HPC evaluate and report on the overall performance of intervention is likely to be effective, and how an intervention the SA health system in relation to: could be targeted and resourced. Consideration of these factors should form the basis for any future activity planning. > strategic objectives that have been set or adopted within Government’s health portfolios The South Australian Areas to Act report gathers and analyses relevant admissions from both public and private > international, national, and state health system hospitals. This analysis considered admissions for 15 years performance standards and benchmarks from 2004 to 2018. Demographic and geospatial data provide > significant trends, health outcomes and future priorities of a picture of all PPAs across SA and identifies hot SA2s with the health system rates substantially above the state average for three-year rolling periods between 2014 to 2018. > the latest research on best practice models of health care services including for specific population groups. The compiled tables and figures provide information into PPA types and the geographical locations which contribute to the burden of disease in SA. 3.3 The Adelaide and Country SA PHNs The Adelaide PHN and Country SA PHN support an 3.1 Department for Health and Wellbeing integrated primary health care system through the design of innovative and flexible services, programs and other activities. The DHW supports the delivery of public health services PHNs work to enhance the efficiency and effectiveness of and is committed to protecting and improving the health of primary healthcare services in their region and improve the the SA population by providing leadership in health reform, coordination of patient care. Guided by community, clinical public health services, health and medical research, policy and stakeholder input, PHNs have the goal of improving development, and planning, with an increased focus on health outcomes for the community. wellbeing, illness prevention, early intervention, and quality care. SA Health is the brand for the health portfolio of services and agencies responsible to the Minister for Health and Wellbeing.

6 Areas to Act: A South Australian Review of Potentially Preventable Admissions 4. DEFINITIONS

4.1 What is a PPA? A Potentially Preventable Admission (PPA) is an admission to either a public or private hospital for a condition where the hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community settings by general practitioners (GPs), medical specialists, dentists, nurses, or allied health professionals (AIHW, 2019). PPAs can also be referred to as Potentially Preventable Hospitalisations or Ambulatory Care Sensitive Conditions (Falster, M and Jorm, L., 2017) and the terms are often used interchangeably. Potentially preventable admissions are identified from diagnoses recorded in hospital admissions data. As described in the Australian Health Performance Framework (COAG, 2017), the current Australian PPA indicator includes 22 conditions for which hospital admission is considered potentially preventable across 3 broad categories which describe the types of conditions: Acute conditions, Chronic conditions, and Vaccine-preventable conditions (Falster, M and Jorm, L., 2017). PPA conditions with more than 10 hospital admissions state- wide for a particular year were included in this analysis. See Appendix 8.1 for the list of PPA conditions with less than 10 hospital admissions excluded from analysis. A summary of the PPA hierarchy is provided in Figure 1.

Areas to Act: A South Australian Review of Potentially Preventable Admissions 7 4. DEFINITIONS (CONTINUED)

Figure 1: Summary of Aggregate, group, and individual level PPA.

Aggregate (Overall) PPA

Vaccine-preventable Acute conditions Chronic conditions conditions

Pneumonia Cellulitis Angina and influenza

Convulsions Other vaccine-preventable Asthma and epilepsy conditions

Dental conditions Bronchiectasis

Ear, nose and Congestive throat infections cardiac failure

Chronic obstructive Eclampsia pulmonary disease

Gangrene Diabetes complications

Pelvic inflammatory Hypertension disease

Pneumonia (not Iron deficiency anaemia vaccine-preventable)

Perforated/ bleeding ulcer Nutritional deficiencies

Urinary tract infections Rheumatic heart diseases

8 Areas to Act: A South Australian Review of Potentially Preventable Admissions 4.2 Rate multiple Where a SA2 has a small population, even small variations in the number of hospitalisations annually can affect whether The rate multiple is the age-sex adjusted rate of separations that area is identified as a hotspot by the method used in in an area, divided by the average state rate for the same this report. Therefore, SA2s with a population less than 1,000 condition(s). A separation is a completed episode of care, persons at any point within the study period were excluded treatment, and/or accommodation of an admitted hospital from this analysis (11 SA2s). A total of 160 SA2s were included patient. A rate multiple of 1 indicates the area’s PPA rate is in this analysis. equal to the average state rate. A rate multiple of 1.5 indicates the area’s rate is at least 1.5 times, or 50% above the average See Appendix 8.2 for list of SA2s excluded from analysis in state rate. this report. PHN boundaries are used to describe the location of 4.3 What is a hotspot? hotspots; hotspots within Adelaide PHN are ‘Metropolitan’ and within Country SA PHN are ‘Country SA’. See Appendix A hotspot is an area with a rate multiple of at least 1.5 times 8.3 for the reference map for Metropolitan and Country SA the average state rate for overall PPA, PPA group, or any one boundaries based on PHN regions in South Australia. particular condition (as outlined in Figure 1 above). An area was identified as a hotspot when the rate multiple was at least 1.5 times the average state rate for three consecutive years between 2014 and 2018. For example, if the rate multiple for a given area was greater than or equal to 1.5 for the years 2014 to 2016, 2015 to 2017, or 2016 to 2018, the given area would be identified as a hotspot. Identified hotspots were then assessed across the whole 15 years of data (2004 - 2018) to determine if the area was a hotspot for any longer than the period identified. The standardised rate is the total number of PPA admissions per 10,000 population and is structured as Aggregate (overall), Group, and Specific PPA conditions. When an area qualified as a hotspot, this indicated the area had persistently higher than average hospitalisation rates for a particular condition, hence an intervention may be warranted. Hotspot rates shown represent the average rate multiple of the last hot period for that area. In this study the geographic area used to analyse PPAs were the Australian Bureau of Statistics (ABS) Statistical Area Level 2 (SA2s). SA2s are general-purpose medium-sized geographical areas which aim to represent a community that interacts together socially and economically. SA2s generally have a population range of 3,000 to 25,000 persons, with an average population of about 10,000 persons (ABS, 2016).

Areas to Act: A South Australian Review of Potentially Preventable Admissions 9 5. RESULTS

This study assessed PPA rates at three 5.1 Aggregate (overall) hotspots levels: All 22 PPA conditions aggregated identified twelve hotspots. 1. Aggregate (overall) hotspots (22 PPA conditions The identified Metropolitan hotspots were: combined). > Elizabeth 2. Group hotspots (Acute, Chronic, and Vaccine-preventable). > Hackham West - Huntfield Heights 3. Specific PPA condition hotspots (22 PPA conditions > Christie Downs individually). > Smithfield - Elizabeth North This report includes 15 hotspot maps: one each for aggregate > Davoren Park and group level, and the top 10 PPA conditions with the highest number of hotspots per area. These maps use a heat Country SA hotspots were: gradient where the greater the rate multiple or ‘hotter’, the > Renmark more deeply shaded red the hotspot area. > Port Augusta Map 1 Aggregate (overall) hotspots > Ceduna Map 2 Acute conditions hotspots > Berri Map 3 Chronic conditions hotspots > Port Pirie > Millicent Map 4 Vaccine-preventable conditions hotspots > The Coorong Map 5 Chronic obstructive pulmonary disease (COPD) hotspots Map 6 Convulsions and epilepsy hotspots Map 7 Diabetes complications hotspots Map 8 Angina hotspots Map 9 Other vaccine-preventable conditions hotspots Map 10 Asthma hotspots Map 11 Congestive cardiac failure (CCF) hotspots Map 12 Dental conditions hotspots Map 13 Ear, nose, and throat (ENT) infections hotspots Map 14 Cellulitis hotspots Map 15 Hot areas based on number of hotspot qualifying conditions

10 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 1: Aggregate (overall) hotspots

South Australian Health and Wellbeing Strategy 2020 – 2025 11 On average, between 2014 and 2018 there were 521 Figure 2 shows the average admissions per 10,000 persons admissions per 10,000 persons per year, per hotspot. During and rate multiple for the last hot period for the identified this period, Elizabeth recorded the highest aggregate (overall) hotspots. PPA rate.

3.0 900 3.0 800 2.5 700 2.0 2.0 1.9 600 2.0 1.8 1.8 1.7 1.7 1.7 1.7 1.6 1.6 500 1.5 400 300 1.0 200 0.5 100 per year for the last hot period 832 832 832 832 490 490 484 481 468 463 455 441

Average admissions per 10k persons Average 0 0.0 Average rate multiple for the last hot period Average Berri Elizabeth Renmark Ceduna Port Pirie Millicent Port Augusta The Coorong Christie Downs Davoren Park

Smithfield - Elizabeth North

Hackham West - Huntfield Heights SA2s Average admissions per 10k persons for the last hot period Average rate multiple for the last hot period

Figure 2: Average admissions per 10,000 persons and rate multiple for last hot period for aggregate (overall) PPA between 2014 and 2018.

Upon review of the identified hotspots, subsequent analysis of all 15 years of data (2004 and 2018) revealed: > Elizabeth, Port Pirie, Ceduna, Port Augusta, Berri, and Renmark were hot for all 15 years. > The Coorong was a hotspot for 14 years. > Davoren Park, Christie Downs, and Hackham West - Huntfield Heights were hot for 13 years > Smithfield – Elizabeth North, and Millicent were hot for 11 years.

12 Areas to Act: A South Australian Review of Potentially Preventable Admissions 5.2 Group level hotspots Country SA hotspots were: > Ceduna This report also examined PPA conditions in their respective groups (acute, chronic, and vaccine-preventable) as > Renmark previously described in Figure 1. > Port Pirie > Port Augusta 5.2.1 Acute conditions hotspots > Berri When all 10 acute PPA conditions were grouped together, > Millicent ten individual hotspots were identified. Eight of these > Coober Pedy hotspots were located in country SA and two were within the metropolitan area. > The Coorong On average, between 2014 and 2018 there were 230 acute Metropolitan hotspots for acute conditions were: condition admissions per 10,000 persons per year, per > Elizabeth hotspot. During this period, Ceduna recorded the highest PPA > Smithfield - Elizabeth North rate for acute conditions. Figure 3 shows the average admissions per 10,000 persons and rate multiple for the last hot period for the identified acute conditions hotspots.

2.5 350 2.2 2.1 300 1.8 1.7 1.7 1.7 1.7 1.7 2.0 250 1.6 1.5 200 1.5

150 1.0 100 0.5 50 286 277 232 226 223 221 221 214 208 199

per year for the last hot period 0 0.0 Average admissions per 10k persons Average Berri CedunaRenmarkPort Pirie Millicent Elizabeth rate multiple for the last hot period Average Port Augusta Coober Pedy The Coorong

Smithfield - Elizabeth North SA2s Average admissions per 10k persons for the last hot period Average rate multiple for the last hot period

Figure 3: Average admissions per 10,000 persons and rate multiple for last hot period for acute conditions between 2014 and 2018.

Analysis of all 15 years of data for the identified hotspots revealed that between 2004 and 2018: > Port Pirie, Ceduna, Coober Pedy, Port Augusta, Renmark and The Coorong were hot for 15 years. > Berri and Elizabeth were hot for 14 and 10 years respectively.

Areas to Act: A South Australian Review of Potentially Preventable Admissions 13 Map 2: Acute conditions hotspots

14 Areas to Act: A South Australian Review of Potentially Preventable Admissions 5.2.2 Chronic conditions hotspots Country SA hotspots for chronic conditions were: An assessment of 10 chronic conditions grouped together > Port Augusta resulted in the identification of 16 hotspots. > Berri Metropolitan hotspots for chronic conditions were: > Renmark > Elizabeth > Port Pirie > Davoren Park > Quorn - Lake Gilles > Hackham West - Huntfield Heights > Millicent > Smithfield - Elizabeth North > The Coorong > Port Adelaide Between 2014 and 2018, on average there were 232 > Hackham - Onkaparinga Hills admissions per 10,000 persons per year, per hotspot for > Christie Downs chronic conditions. During this period, Port Augusta recorded the highest PPA rate for chronic conditions. > Salisbury North > Salisbury Figure 4 shows the average admissions per 10,000 persons and rate multiple for the last hot period for the identified chronic conditions hotspots.

2.5 350 2.3 2.1 2.0 2.0 300 2.0 1.9 1.8 1.8 1.8 1.7 1.7 1.7 1.7 1.7 1.6 1.6 1.5 250 1.5 200 150 1.0 100 0.5 50 292 264 260 259 247 235 233 232 225 220 219 215 213 212 207 195 0 0.0 per year for the last hot period Average admissions per 10k persons Average Berri Average rate multiple for the last hot period Average RenmarkElizabeth Port Pirie Millicent Salisbury Port Augusta Davoren Park Port Adelaide The Coorong Christie SalisburyDowns North Quorn - Lake Gilles

Smithfield - Elizabeth North Hackham - Onkaparinga Hills Hackham West - Huntfield Heights SA2s Average admissions per 10k persons for the last hot period Average rate multiple for the last hot period

Figure 4: Average admissions per 10,000 persons and rate multiple for last hot period for chronic conditions between 2014 and 2018.

A review of all the 15 years of data (2004 to 2018) revealed: > Davoren Park, Elizabeth, Christie Downs, Port Augusta and Renmark were hot for 15 years. > Smithfield - Elizabeth North, Hackham West - Huntfield Heights and Port Pirie were hot for 14 out of 15 years. > Berri, Millicent and Salisbury North were hot for 13, 11 and 10 years respectively.

Areas to Act: A South Australian Review of Potentially Preventable Admissions 15 Map 3: Chronic conditions hotspots

16 Areas to Act: A South Australian Review of Potentially Preventable Admissions 5.2.3 Vaccine-preventable conditions hotspots > Christies Beach An assessment of the two vaccine-preventable conditions > Port Adelaide grouped together resulted in the identifcation of fourteen > Woodville - Cheltenham hotspots with thirteen located in metropolitan area and one in > Enfield - Blair Athol country SA. Country SA hotspots was: The Metropolitan hotspots were: > Port Augusta > Elizabeth Between 2014 and 2018, on average there were 69 > The Parks admissions per 10,000 persons per year, per hotspot for > Christie Downs vaccine-preventable conditions. During this period, Elizabeth > Smithfield - Elizabeth North recorded the highest PPA rate for vaccine preventable > Virginia - Waterloo Corner conditions. > Salisbury North Figure 5 shows the average admissions per 10,000 persons > Parafield Gardens and rate multiple for the last hot period for the identified vaccine-preventable conditions hotspots. > Davoren Park > Salisbury

400 17.1 18.0 350 16.0 300 14.0 12.0 250 10.0 200 8.0 150 6.0 100 2.5 2.3 2.2 2.0 4.0 1.8 1.9 1.8 1.9 1.8 1.7 1.8 1.9 1.6

per year for the last hot period 50 2.0 375 58 57 51 51 46 45 45 43 42 40 40 39 37

Average admissions per 10k persons Average 0 0.0

ElizabethThe Parks Salisbury rate multiple for the last hot period Average Port AugustaDavoren Park Port Adelaide Christie Downs SalisburyChristies North Beach ParafieldEnfield Gardens - Blair Athol Woodville - Cheltenham SmithfieldVirginia - Elizabeth - Waterloo North Corner SA2s Average admissions per 10k persons for the last hot period Average rate multiple for the last hot period

Figure 5: Average admissions per 10,000 persons and rate multiple for last hot period for vaccine-preventable conditions from 2014 to 2018.

A review of all the 15 years of data (2004 to 2018) revealed: > Elizabeth and Port Augusta were hot for vaccine-preventable conditions for 14 years > Daveron Park was hot for 11 years. > Salisbury North and The Parks were hot for 10 years.

Areas to Act: A South Australian Review of Potentially Preventable Admissions 17 Map 4: Vaccine-preventable conditions hotspots

18 Areas to Act: A South Australian Review of Potentially Preventable Admissions 5.3 Specific PPA conditions not vaccine-preventable, bleeding/perforated ulcer, bronchiectasis, hypertension, nutritional deficiencies and The 22 PPA conditions were assessed individually by SA2 rheumatic heart diseases. Table 1 provides a summary of the against the state average admission rate. Hotspots were number of hotspots for each condition. identified for thirteen of the 22 conditions; no SA2s met the hotspot criteria for the PPA conditions of eclampsia, gangrene, pelvic inflammatory disease, pneumonia

Number of hotspots by PPA condition PPA Group PPA condition Hotspots Cellulitis 12 Convulsions and epilepsy 20 Acute Dental conditions 14 Ear, nose and throat infections 13 Urinary tract infections 8 Anaemia 4 Angina 17 Asthma 15 Chronic Congestive cardiac failure 14 Chronic obstructive pulmonary disease 22 Diabetes complications 18 Vaccine- Other vaccine-preventable conditions 15 preventable Pneumonia and influenza (vaccine-preventable) 4

Table 1: Summary of individual PPA conditions and number of hotspots

5.3.1 Top 10 PPA conditions in SA 8. Dental conditions – 14 Based on the number of hotspots identified for each PPA 9. Ear, nose and throat infections – 13 condition, the top 10 PPA conditions in SA were identified. 10. Cellulitis – 12 The top 10 conditions were: Figure 6 shows the top 10 PPA conditions identified with the 1. Chronic obstructive pulmonary disease – 22 number of hotspots for each condition and the proportion of hotspots located in the metropolitan area. 2. Convulsions and epilepsy – 20 3. Diabetes complications – 18 4. Angina – 17 5. Other vaccine-preventable conditions – 15 6. Asthma - 15 7. Congestive cardiac failure – 14

Areas to Act: A South Australian Review of Potentially Preventable Admissions 19 25 100% 90% 20 93% 80% 59% 70% 15 60% 50% 59% 50% 35% 56% 36% 10 50% 40% 30% 33% 15% 5 20% 22 20 18 17 15 15 14 14 13 12 10% 0 0% Number of Hotspots identified % of Hotspots Located in Metro % of Hotspots Located

COPD Angina Dental Epilepsy Diabetes Asthma Cellulitis

Ear, Nose and Throat Congestive Cardiac Failure

Other vaccine preventable conditions PPA Condition Number of hotspots identified % of Hotspots located in Metro

Figure 6: Top 10 PPAs with the number of identified hotspots and the proportion located in the metropolitan area.

Results show the majority of hotspots for the top 10 PPAs Country SA hotspots were: were located in country SA. The exceptions were chronic > Berri obstructive pulmonary disease, diabetes complications, > Port Augusta angina and other vaccine-preventable conditions which had a higher proportion of hotspots in metropolitan Adelaide. > Quorn - Lake Gilles > Ceduna 5.3.1.1 Chronic obstructive pulmonary disease (COPD) > The Coorong This study identified 22 hotspots for COPD, of which thirteen > Port Pirie were located in the metropolitan area and nine in country SA. > Renmark Metropolitan hotspots were: > Naracoorte > Davoren Park > Murray Bridge > Elizabeth Between 2014 and 2018, on average there were 72 > Smithfield - Elizabeth North admissions per 10,000 persons per year, per hotspot for > Hackham West - Huntfield Heights COPD. The highest admission rate for COPD over this period > Christie Downs was observed in Davoren Park with 98 admissions per 10,000 > Elizabeth East persons per year and a rate multiple 3.1 times higher than the state average. > Salisbury > Salisbury North When 15 years of data from 2004 to 2018 was analysed: > Port Adelaide > Davoren Park, Elizabeth, Elizabeth East, Christie Downs, > Royal Park - Hendon - Albert Park Hackham West - Huntfield Heights and Port Augusta were hot for 15 years. > Christies Beach > Virginia - Waterloo Corner > Smithfield - Elizabeth North, Salisbury North, Port Pirie and Renmark were hot for 14 out of 15 years. > Morphettville > Berri and Ceduna were hot for 13 and 12 years respectively.

20 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 5: Chronic obstructive pulmonary disease hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 21 5.3.1.2 Convulsions and epilepsy When 15 years of data from 2004 to 2018 was analysed: Of the 20 hotspots identified for convulsions and epilepsy, seven > Whyalla and Port Augusta were hot for 15 years. were located in the metropolitan area and 13 in country SA. > Murray Bridge was hot for 14 years. The Metropolitan hotspots were: > Elizabeth, Ceduna and Coober Pedy were hot for 13 years. > Elizabeth > Smithfield - Elizabeth North and Goolwa - Port Elliot were hot for 11 years. > Christie Downs > Christie Downs, Wallaroo, Yorke Peninsula – North and > Smithfield - Elizabeth North Renmark were hot for 10 years. > Davoren Park > Mitchell Park > Hackham - Onkaparinga Hills > Salisbury Country SA hotspots were: > Ceduna > Coober Pedy > Peterborough - Mount Remarkable > Yorke Peninsula - North > Port Augusta > Renmark > The Coorong > Wallaroo > Millicent > Barmera > Goolwa - Port Elliot > Whyalla > Murray Bridge On average, between 2014 and 2018 there were 40 admissions per 10,000 persons per year, per hotspot for convulsions and epilepsy. The highest admission rate for convulsions and epilepsy over this period was observed in Ceduna with 150 admissions per 10,000 persons per year and a rate multiple 9.9 times higher than the state average

22 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 6: Convulsions and epilepsy hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 23 5.3.1.3 Diabetes complications When 15 years of data from 2004 to 2018 was analysed: This study identified 18 hotspots for diabetes complications, > Port Pirie and Port Augusta were hot for 15 years. of which ten hotspots were located in the metropolitan area > Elizabeth was hot for 14 years. and eight in country SA. > Davoren Park, Hackham West - Huntfield Heights, Port Metropolitan hotspots for were: Adelaide, West Coast (SA) and Whyalla were hot for 12 > Christie Downs years. > Elizabeth > Hackham - Onkaparinga Hills and Christie Downs were hot for 11 years and 10 years respectively. > Port Adelaide > Davoren Park > Salisbury North > Hackham - Onkaparinga Hills > Salisbury > Smithfield - Elizabeth North > Hackham West - Huntfield Heights > Parafield Gardens Country SA hotspots for were: > Karoonda - Lameroo > Nuriootpa > Renmark > Port Augusta > Murray Bridge > Port Pirie > West Coast (SA) > Whyalla On average, between 2014 and 2018, there were 46 admissions per 10,000 persons per year, per hotspot. The highest admission rate for diabetes complications over this period was observed in Karoonda – Lameroo, with 66 admissions per 10,000 persons per year and a rate multiple 3.4 times higher than the state average.

24 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 7: Diabetes complications hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 25 5.3.1.4 Angina When 15 years of data from 2004 to 2018 was analysed: This study identified 17 hotspots for angina, of which ten > Davoren Park and Smithfield - Elizabeth North were hot hotspots were located in the metropolitan area and seven in for 14 years. country SA. > Salisbury, Salisbury North and Wallaroo were hot for 13 Metropolitan hotspots were: years. > Smithfield - Elizabeth North > Kadina and Port Augusta were hot for 12 years. > Salisbury North > Gawler – South and Port Adelaide were hot for 11 years. > Hindmarsh - Brompton > West Lakes > Davoren Park > Walkerville > Port Adelaide > North Haven > Woodville - Cheltenham > Salisbury Country SA hotspots were: > Port Augusta > Wallaroo > Yorke Peninsula - North > Gilbert Valley > Kadina > Gawler - South > Mount Gambier - East and West On average, between 2014 and 2018 there were 33 angina admissions per 10,000 persons per year, per hotspot. The highest admission rate for angina over this period was observed in Port Augusta with 63 admissions per 10,000 persons per year and a rate multiple 4.5 times higher than the state average.

26 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 8: Angina hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 27 5.3.1.5 Other vaccine-preventable conditions When 15 years of data from 2004 to 2018 was analysed: This study identified 15 hotspots for other vaccine- > Port Augusta was hot for 13 years. preventable conditions, of which 14 were located in the > No other SA2s were hot for more than 10 years. metropolitan area and one in country SA. The Metropolitan hotspots were: > Elizabeth > The Parks > Christie Downs > Enfield - Blair Athol > Salisbury North > Woodville - Cheltenham > Adelaide > Davoren Park > Port Adelaide > Parafield Gardens > Edwardstown > Smithfield - Elizabeth North > Salisbury > Seaton - Grange The country hotspot was: > Port Augusta On average, between 2014 and 2018 there were 42 admissions per 10,000 persons per year, per hotspot. The highest admission rate during this period was observed in Elizabeth with 338 admissions per 10,000 persons per year and a rate multiple of 36.7 higher than the state average.

28 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 9: Other vaccine-preventable conditions hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 29 5.3.1.6 Asthma When 15 years of data from 2004 to 2018 was analysed: This study identified 15 hotspots for asthma, of which five > Elizabeth and Renmark were hot for 15 and 14 years, hotspots were located in the metropolitan area and ten in respectively. country SA. > Port Augusta, Goolwa - Port Elliot and The Coorong were The Metropolitan hotspots were: hot for 13 years. > Elizabeth > Christie Downs and Mannum were hot for 12 and 11 years, respectively. > Hackham - Onkaparinga Hills > Christie Downs > Munno Para West - Angle Vale > Salisbury North Country SA hotspots were: > Nairne > Renmark > Strathalbyn > The Coorong > Mannum > Victor Harbor > Port Augusta > Naracoorte > Goolwa - Port Elliot > Gawler – South On average, between 2014 and 2018 there were 27 asthma admissions per 10,000 persons per year, per hotspot. The highest admission rate for asthma over this period was observed in Nairne, with 47 admissions per 10,000 persons per year and a rate multiple 3.8 times higher than the state average.

30 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 10: Asthma hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 31 5.3.1.7 Congestive cardiac failure When 15 years of data from 2004 to 2018 was analysed: This study identified 14 hotspots for congestive cardiac failure, > Port Augusta and Millicent were hot for 14 and 13 years seven were located in the metropolitan area and seven in respectively. country SA. > Port Pirie and Berri were hot for 12 years. The Metropolitan hotspots were: > Elizabeth, Paralowie, Hackham - Onkaparinga Hills and > Hackham - Onkaparinga Hills Renmark were hot for 10 years. > Port Adelaide > Paralowie > Elizabeth > Edwardstown > Virginia - Waterloo Corner > Smithfield - Elizabeth North Country SA hotspots for were: > Berri > Millicent > Port Pirie > Renmark > Naracoorte > Port Augusta > Kangaroo Island On average, between 2014 and 2018 there were 44 admissions per 10,000 persons per year, per hotspot. The highest admission rate for congestive cardiac failure over this period was observed in Hackham - Onkaparinga Hills, with 60 admissions per 10,000 persons per year and a rate multiple 2.6 times the state average.

32 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 11: Congestive cardiac failure hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 33 5.3.1.8 Dental conditions When 15 years of data from 2004 to 2018 was analysed: This study identifed 14 hotspots for dental conditions, five > Renmark and Berri were hot for 15 and 14 years located in the metropolitan area and nine in country SA respectively. The Metropolitan hotspots for dental were: > Port Pirie and Port Augusta were hot for 13 years. > One Tree Hill > Ceduna and Barmera were hot for 12 years. > Nailsworth - Broadview > Toorak Gardens, Nuriootpa and Tanunda were hot for 11 years. > Toorak Gardens > Walkerville > Belair Country SA hotspots for dental were: > Renmark > Barmera > Nuriootpa > Tanunda > Berri > Ceduna > Goolwa - Port Elliot > Port Pirie > Port Augusta On average, between 2014 and 2018 there were 69 admissions per 10,000 persons per year, per hotspot. The highest admission rate for Dental conditions over this period was observed in Renmark, with 104 admissions per 10,000 persons per year and a rate multiple 2.6 times the state average.

34 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 12: Dental conditions hotpots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 35 5.3.1.9 Ear, nose and throat infections When 15 years of data from 2004 to 2018 was analysed: A total of 13 hotspots were identified for ear, nose and throat > Port Pirie and The Coorong were hot for 15 years. infections, of which two were located in the metropolitan area > Yorke Peninsula – North, Port Augusta and Renmark were and eleven in country SA. hot for 12 years. The Metropolitan hotspots identified were: > Tatiara and Berri were hot for 11 years. > Smithfield - Elizabeth North > Port Lincoln and West Coast (SA) were hot for 10 years. > Elizabeth Country SA hotspots were: > The Coorong > Millicent > Renmark > Port Augusta > Berri > Tatiara > West Coast (SA) > Yorke Peninsula - North > Port Pirie > Port Lincoln > Eyre Peninsula On average, between 2014 and 2018 there were 36 admissions per 10,000 persons per year, per hotspot. The highest admission rate for ENT over this period was observed in The Coorong, with 61 admissions per 10,000 persons per year and a rate multiple 3.7 times the state average.

36 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 13: Ear, nose and throat infections hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 37 5.3.1.10 Cellulitis When 15 years of data from 2004 to 2018 was analysed: A total of 12 hotspots were identified for cellulitis, of which six > Port Pirie was hot for 15 years. were located in the metropolitan area and six in country SA. > Christie Downs and Port Augusta were hot for 14 years. The Metropolitan hotspots identified were: > Millicent and The Coorong were hot for 13 years. > Hackham West - Huntfield Heights > Smithfield - Elizabeth North and Ceduna were hot for 12 > Christie Downs years. > Christies Beach > Hackham - Onkaparinga Hills and Hackham West - Huntfield Heights were hot for 10 years. > Hackham - Onkaparinga Hills > Smithfield - Elizabeth North > Adelaide Country SA hotspots were: > Ceduna > Port Pirie > Millicent > Port Augusta > Waikerie > The Coorong On average, between 2014 and 2018 there were 47 admissions per 10,000 persons per year, per hotspot. The highest admission rate for Cellulitis during this period was observed in Hackham West - Huntfield Heights with 95 admissions per 10,000 persons per year and a rate multiple 4.1 times higher than the state average.

38 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 14: Cellulitis hotspots

Areas to Act: A South Australian Review of Potentially Preventable Admissions 39 5.4 Top 15 hot SA2s Country SA SA2s that were identified in top 15 hotspots were: The hottest SA2s were identified based on the total number > Port Augusta of hotspot qualifying conditions. See Appendix 8.1 for the list of PPA conditions that qualified for condition-level analysis. > Renmark > Port Pirie Eight of the top 15 hot areas were located in metropolitan area. > Ceduna > Berri Metropolitan SA2s that were identified in top 15 hotspots were: > The Coorong > Elizabeth > Millicent > Smithfield - Elizabeth North Figure 7 shows the top 15 areas based on the total number of > Christie Downs hotspot qualifying PPA conditions. > Davoren Park > Salisbury North > Salisbury > Port Adelaide > Hackham - Onkaparinga Hills

12 10 8 6 4 2 10 9 9 8 7 7 6 6 5 5 5 5 5 5 5 0

Berri Ceduna RenmarkElizabeth Port Pirie Salisbury Millicent Port Augusta Davoren Park The CoorongPort Adelaide Christie Downs Salisbury North

Number of hotspot qualifing conditions Smithfield - Elizabeth North Hackham - Onkaparinga Hills SA2s Number of Hotspot Qualifying Conditions

Figure 7: Top 15 SA2 areas based on total number of hotspot qualifying conditions

40 Areas to Act: A South Australian Review of Potentially Preventable Admissions Map 15: Hot areas based on number of hotspot qualifying conditions

Areas to Act: A South Australian Review of Potentially Preventable Admissions 41 6. KEY MESSAGES AND POTENTIAL 7. LIMITATIONS FUTURE WORK OF THIS REPORT

The findings of this collaborative project between DHW, HPC, Even though this study assessed 15 years of data, hotspots Adelaide PHN, and Country SA PHN identifies geographical were identified based on the rate multiple from 2014 to 2018. hotspots of persistent PPAs across SA. Some SA2s had a rate multiple greater than or equal to 1.5 times for many of the years in the 15-year period assessed. Findings on overall PPAs from 2004 to 2018 indicate that six However, these SA2s did not qualify as a hotspot for this SA2s, Elizabeth, Port Pirie, Ceduna, Port Augusta, Berri, and report because the rate multiple was not greater than or Renmark, are hotspots that have persisted for all 15 years. equal to 1.5 times for three consecutive years from 2014 to With the exception of Elizabeth SA2, the other persistent 2018. hotspots are in Country SA. These hotspots, along with those identified in the group- and condition-level analyses indicate Given the importance for both primary (specifically the PHNs) the areas of greatest need in terms of PPAs. and acute health sectors to work together it was decided that the analysis will be based on Adelaide PHN (Metropolitan) The potential for future work may include, but is not limited to, and Country SA PHN (Country SA) SA2 ASGS boundaries the following activities: rather than other administrative boundaries. > Further analysis to demonstrate the difference between The report excludes SA2s with a population less than 1,000 PPA rates for Aboriginal and Torres Strait Islander persons in any year from 2004 to 2018 and resulted in nine populations and non-Indigenous Australians in South SA2s excluded from the analysis. Seven of the SA2s are in Australia. Metropolitan while the remaining two in Country SA. The > Further investigation into age and gender to help target methodology used also excluded PPA conditions with an future action for specific PPA conditions. average of less than 10 hospital admissions in a particular year. These exclusions limit the production of false positive > Further consideration needs to be given to SA2 areas in hotspots. SA with a population less than 1,000. Finally, mental health conditions are not included in the > Review SA2s by Socio-Economic Indexes for Areas national classification of PPAs and hence not included in the (SEIFA) to investigate the influence of social determinants data set for analysis. However, the organisations involved in of health on PPAs and resulting hotspots. this joint collaborative project acknowledge the importance > Analyse routinely collected administrative data to improve of early intervention strategies and access to culturally coding diagnosis of PPA conditions. appropriate psychological therapies in preventing hospital > Joint collaborative projects to improve communication admissions for some mental health conditions. Consequently, and referral pathways between primary and acute care joint collaborative and advocacy work are required at State sectors. and national levels to improve access and referral pathways to mental health services in primary and acute health sectors. > Data sharing arrangements to improve policy and planning for PPAs between primary and acute care sectors. It is important that DHW, the LHNs and the PHNs continue this joint collaborative work in order to investigate local factors and variables affecting hotspots.

42 Areas to Act: A South Australian Review of Potentially Preventable Admissions 8. APPENDICES

8.1 PPA conditions excluded from condition-level analysis due to no hotspots or low volume hospital admissions in the reporting period (2014 to 2018)

PPA conditions included and excluded from condition-level analysis Qualifying PPA condition condition Reason for exclusion Angina Yes Asthma Yes Bronchiectasis No No hotspots Congestive cardiac failure Yes Cellulitis Yes Convulsions and epilepsy Yes Chronic obstructive pulmonary disease Yes Dental conditions Yes Diabetes complication Yes Ear, nose and throat infections Yes Gangrene No Low volume hospital admission Hypertension No Low volume hospital admission Influenza and pneumonia Yes Iron deficiency anaemia Yes Other vaccine-preventable Yes Pelvic inflammatory disease No No hotspots Perforated bleeding ulcer No Low volume hospital admission Pneumonia non vaccine-preventable No No hotspots Rheumatic heart disease No No hotspots Urinary tract infection Yes

8.2 SA2s excluded from analysis due to small population counts (less than 1,000) in the reporting period (2014 to 2018)

SA2s with populations less than 1,000 in reporting period SA2 Code SA2 Name SA2 hotspot group PHN region 402041039 Dry Creek - North Metropolitan Adelaide 402041042 Parafield Metropolitan Adelaide 403041081 Happy Valley Reservoir Metropolitan Adelaide 403041082 Lonsdale Metropolitan Adelaide 404021098 Dry Creek - South Metropolitan Adelaide 404021103 Torrens Island Metropolitan Adelaide 404031104 Adelaide Airport Metropolitan Adelaide 406011135 Western Country SA Country SA 406011137 Whyalla - North Country SA Country SA

Areas to Act: A South Australian Review of Potentially Preventable Admissions 43 8.3 Reference map and area key

Map 16: Key map

44 Areas to Act: A South Australian Review of Potentially Preventable Admissions Table 4: Key map reference table

Map Map Label SA2 Code* SA2 Name PHN region Label SA2 Code* SA2 Name PHN region 1 401011001 Adelaide Adelaide 45 402041046 Salisbury Adelaide 2 401011002 North Adelaide Adelaide 46 402041047 Salisbury East Adelaide 3 401021003 Adelaide Hills Country SA 47 402041048 Salisbury North Adelaide 4 401021004 Aldgate - Stirling Country SA 48 *402041045 Pooraka - Cavan Adelaide 5 401021005 Hahndorf - Echunga Country SA 49 402051049 Golden Grove Adelaide 6 401021006 Lobethal - Woodside Country SA 50 402051050 Greenwith Adelaide 7 401021007 Mount Barker Country SA 51 402051051 Highbury - Dernancourt Adelaide 8 401021008 Mount Barker Region Country SA 52 402051052 Hope Valley - Modbury Adelaide 9 401021009 Nairne Country SA 53 402051053 Modbury Heights Adelaide 10 401021010 Uraidla - Summertown Country SA 54 402051054 Redwood Park Adelaide 11 401031011 Burnside - Wattle Park Adelaide 55 402051055 St Agnes - Ridgehaven Adelaide 12 401031012 Glenside - Beaumont Adelaide 56 403011056 Brighton (SA) Adelaide 13 401031013 Toorak Gardens Adelaide 57 403011057 Glenelg (SA) Adelaide 14 401041014 Athelstone Adelaide 58 403021058 Edwardstown Adelaide 15 401041015 Paradise - Newton Adelaide 59 403021059 Hallett Cove Adelaide 16 401041016 Rostrevor - Magill Adelaide 60 403021060 Marino - Seaview Downs Adelaide 17 401051017 Norwood (SA) Adelaide 61 403021061 Mitchell Park Adelaide 18 401051018 Payneham - Felixstow Adelaide 62 403021062 Morphettville Adelaide 19 401051019 St Peters - Marden Adelaide 63 403021063 Sheidow Park - Trott Park Adelaide 20 401061020 Nailsworth - Broadview Adelaide 64 403021064 Warradale Adelaide 21 401061021 Prospect Adelaide 65 403031065 Belair Adelaide 22 401061022 Walkerville Adelaide 66 403031066 Bellevue Heights Adelaide 23 401071023 Goodwood - Millswood Adelaide 67 403031067 Blackwood Adelaide 24 401071024 Unley - Parkside Adelaide 68 403031068 Colonel Light Gardens Adelaide 25 402011025 Gawler - North Country SA 69 403031069 Mitcham (SA) Adelaide 26 402011026 Gawler - South Country SA 70 403031070 Panorama Adelaide 27 402011027 Lewiston - Two Wells Country SA 71 403041071 Aberfoyle Park Adelaide 28 402021028 Craigmore - Blakeview Adelaide 72 403041072 Aldinga Adelaide 29 402021029 Davoren Park Adelaide 73 403041073 Christie Downs Adelaide 30 402021030 Elizabeth Adelaide 74 403041074 Christies Beach Adelaide 31 402021031 Elizabeth East Adelaide 75 403041075 Clarendon Adelaide 32 402021032 Munno Para West - Angle Vale Adelaide 76 403041076 Coromandel Valley Adelaide 33 402021033 One Tree Hill Adelaide 77 403041077 Flagstaff Hill Adelaide 34 402021034 Smithfield - Elizabeth North Adelaide 78 403041078 Hackham - Onkaparinga Hills Adelaide 35 402021035 Virginia - Waterloo Corner Adelaide 79 403041079 Hackham West - Huntfield Heights Adelaide 36 402031036 Enfield - Blair Athol Adelaide 80 403041080 Happy Valley Adelaide 37 402031037 Northgate - Oakden - Gilles Plains Adelaide 81 403041081 Happy Valley Reservoir Adelaide 38 402031038 Windsor Gardens Adelaide 82 403041082 Lonsdale Adelaide 39 402041039 Dry Creek - North Adelaide 83 403041083 McLaren Vale Adelaide 40 402041040 Ingle Farm Adelaide 84 403041176 Morphett Vale - East and West Adelaide 41 402041041 Para Hills Adelaide 85 403041086 Reynella Adelaide 42 402041042 Parafield Adelaide 86 403041087 Seaford (SA) Adelaide 43 402041043 Parafield Gardens Adelaide 87 403041088 Willunga Adelaide 44 402041044 Paralowie Adelaide 88 403041089 Woodcroft Adelaide

Areas to Act: A South Australian Review of Potentially Preventable Admissions 45 Map Map Label SA2 Code* SA2 Name PHN region Label SA2 Code* SA2 Name PHN region 89 404011090 Beverley Adelaide 133 406011134 West Coast (SA) Country SA 90 404011091 Flinders Park Adelaide 134 406011135 Western Country SA 91 404011092 Henley Beach Adelaide 135 406011136 Whyalla Country SA 92 404011093 Hindmarsh - Brompton Adelaide 136 406011137 Whyalla - North Country SA 93 404011094 Royal Park - Hendon - Albert Park Adelaide 137 406021138 APY Lands Country SA 94 404011095 Seaton - Grange Adelaide 138 406021139 Coober Pedy Country SA 95 404011096 West Lakes Adelaide 139 406021140 Quorn - Lake Gilles Country SA 96 404011097 Woodville - Cheltenham Adelaide 140 406021141 Outback Country SA 97 404021098 Dry Creek - South Adelaide 141 406021142 Port Augusta Country SA 98 404021099 Largs Bay - Semaphore Adelaide 142 406021143 Roxby Downs Country SA 99 404021100 North Haven Adelaide 143 407011144 Goolwa - Port Elliot Country SA 100 404021101 Port Adelaide Adelaide 144 407011145 Kangaroo Island Country SA 101 404021102 The Parks Adelaide 145 407011146 Strathalbyn Country SA 102 404021103 Torrens Island Adelaide 146 407011147 Strathalbyn Region Country SA 103 404031104 Adelaide Airport Adelaide 147 407011148 Victor Harbor Country SA 104 404031105 Fulham Adelaide 148 407011149 Yankalilla Country SA 105 404031106 Lockleys Adelaide 149 407021150 Grant Country SA 106 404031107 Plympton Adelaide 150 407021151 Kingston - Robe Country SA 107 404031108 Richmond (SA) Adelaide 151 407021152 Millicent Country SA 108 404031109 West Beach Adelaide 152 407021154 Naracoorte Country SA 109 405011110 Barossa - Angaston Country SA 153 407021155 Naracoorte Region Country SA 110 405011111 Light Country SA 154 407021156 Penola Country SA 111 405011112 Lyndoch Country SA 155 407021157 Tatiara Country SA 112 405011113 Mallala Country SA 156 407021158 Wattle Range Country SA 113 405011114 Nuriootpa Country SA 157 *407021175 Mount Gambier - East and West Country SA 114 405011115 Tanunda Country SA 158 407031159 Barmera Country SA 115 405021116 Clare Country SA 159 407031160 Berri Country SA 116 405021117 Gilbert Valley Country SA 160 407031161 Karoonda - Lameroo Country SA 117 405021118 Goyder Country SA 161 407031162 Loxton Country SA 118 405021119 Wakefield - Barunga West Country SA 162 407031163 Loxton Region Country SA 119 405031120 Jamestown Country SA 163 407031164 Mannum Country SA 120 405031121 Peterborough - Mount Remarkable Country SA 164 407031165 Murray Bridge Country SA 121 405031122 Port Pirie Country SA 165 407031166 Murray Bridge Region Country SA 122 405031123 Port Pirie Region Country SA 166 407031167 Renmark Country SA 123 405041124 Kadina Country SA 167 407031168 Renmark Region Country SA 124 405041125 Moonta Country SA 168 407031169 The Coorong Country SA 125 405041126 Wallaroo Country SA 169 407031170 Waikerie Country SA 126 405041127 Yorke Peninsula - North Country SA

127 405041128 Yorke Peninsula - South Country SA Note: SA2s codes marked with * are not official ABS SA2 codes. 128 406011129 Ceduna Country SA Due to changes in ABS SA2 codes between 2006 and 2011 129 406011130 Eyre Peninsula Country SA these regions were merged for analysis and an alternative code provided. 130 406011131 Kimba - Cleve - Franklin Harbour Country SA 131 406011132 Le Hunte - Elliston Country SA 132 406011133 Port Lincoln Country SA

46 Areas to Act: A South Australian Review of Potentially Preventable Admissions 9. REFERENCE LIST

Australian Bureau of Statistics (ABS) (2016) Australian Falster, M and Jorm, L. (2017) A guide to the potentially Statistical Geography Standard (ASGS): Volume 1 - Main preventable hospitalisations indicator in Australia. Centre for Structure and Greater Capital City Statistical Areas, July 2016: Big Data Research in Health, University of New South Wales STATISTICAL AREA LEVEL 2 (SA2). Retrieved from in consultation with Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and https://www.abs.gov.au/ausstats/[email protected]/Lookup/ Welfare: Sydney; by%20Subject/1270.0.55.001~July%202016~Main%20 Features~Statistical%20Area%20Level%202%20(SA2)~10014 Health Performance Council. (2019). Hotspots of potentially preventable hospital admissions. Retrieved from Australian Health Ministers’ Advisory Council. (2015). Aboriginal and Torres Strait Islander Health Performance https://hpcsa.com.au/statistics/hotspots-of-potentially- Framework 2014 Report. AHMAC, Canberra. preventable-hospital-admissions-2019

Australian Institute of Health and Welfare. (2019) National Healthcare Agreement: PI 18–Selected potentially preventable hospitalisations, 2019. Retrieved from https://meteor.aihw.gov.au/content/index.phtml/ itemId/698904

Commonwealth Department of Health. (2018). PHN Program Performance and Quality Framework Appendix B – Indicator Specifications. Retrieved from: https://www1.health.gov.au/internet/main/publishing.nsf/ Content/PHN-Performance_Framework

Council of Australian Governments. (2017). The Australian Health Performance Framework. Retrieved from https://www.coaghealthcouncil.gov.au/Portals/0/OOS318_ Attachment%201.pdf

Duckett, S. and K. Griffiths, (2016), Perils of place: identifying hotspots of health inequalities, Grattan Institute. Retrieved from https://www.grattan.edu.au/wp-content/uploads/2016/07/874- Perils-of-Place.pdf

Areas to Act: A South Australian Review of Potentially Preventable Admissions 47 For more information System Design and Planning System Leadership and Design Level 11, 99 Gawler Place ADELAIDE SA 5000 Telephone: 7117 9966 E-mail: [email protected] www.sahealth.sa.gov.au

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