The Second Australian Atlas of Healthcare Variation shows variation in the use of specific types of health care across more than 300 local areas nationally, with a specific chapter on women’s health. Types of care examined include hysterectomy, cataract surgery, knee replacement and potentially preventable hospitalisations for selected conditions, including diabetes complications.
The Atlas has been developed by the Australian Commission on Safety and Quality in Health Care, and will be launched in Canberra today by the Secretary of the Australian Government Department of Health, Mr Martin Bowles PSM, supported by a number of guest speakers including women’s health campaigner and journalist Mia Freedman.
Hysterectomy is generally becoming less common in developed countries, following the introduction of less invasive but still highly effective treatment options. Evidence suggests women tend to choose these more conservative treatments when offered. However, hysterectomy in Australia remains more common than in many other comparable countries. The Atlas shows rates are up to seven times as high in the area with the highest rate compared to the area with the lowest rate – suggesting that not all women are aware of the range of treatment options available.
Endometrial ablation, a surgical technique for abnormal uterine bleeding, is regarded as less invasive and is therefore often a preferred alternative to hysterectomy for this condition. Endometrial ablation shows even higher variation than hysterectomy, with rates nearly 21 times as high in the highest compared to the lowest areas – the largest difference found in the Atlas. Again, this suggests that not all women are aware of the available treatment options.
Access to effective secondary prevention programs can significantly reduce the need for hospitalisation for many chronic conditions. The new Atlas finds up to 16-fold variations in the rates of hospitalisations for some chronic conditions – representing an improvement opportunity for the health system. The high hospitalisation rates and substantial variations reported in this chapter show that recommended care is not always provided for people with these conditions.
Almost half (47%) of the potentially preventable hospitalisations in Australia in 2014–15 were associated with the five conditions included in a chapter on this topic: chronic obstructive pulmonary disease (COPD), diabetes complications, heart failure, cellulitis and kidney and urinary tract infections. On these and other topics, the Atlas includes the Commission’s recommendations for action across the health system to address variation where this appears to be unwarranted.
The second Atlas also provides information about hospitalisation rates for Aboriginal and Torres Strait Islander Australians, about the percentage of services funded publicly and privately, and includes analysis by socioeconomic status. Aboriginal and Torres Strait Islander Australians have much higher potentially preventable hospitalisation rates for many of the chronic and acute conditions specified in the Atlas: nearly five times as high as other Australians for COPD, and about four times as high for diabetes complications. Aboriginal and Torres Strait Islander Australians also have a 17% lower rate for cataract surgery compared to other Australians, raising questions about equity. The lower rate for cataract surgery is despite the fact that the prevalence of vision loss from cataract is 12 times as high in Aboriginal and Torres Strait Islander populations.
The Commission collaborated with the Australian Government, state and territory governments, specialist medical colleges, clinicians and consumer representatives, and the Australian Institute of Health and Welfare to develop the Atlas.
Atlas Advisory Group chair Professor Anne Duggan, a Senior Medical Advisor for the Commission, said the findings contained a number of good news stories for the health system, as well as new information for clinicians on where efforts could be targeted to improve patient care.
‘Australians are fortunate in having world-class health care, including surgical care. Landmark accomplishments in surgical practice have revolutionised surgical care, saved countless lives, and significantly improved longevity and the quality of life,’ Professor Duggan said.
‘However, there is variation in the use of health care in Australia, including surgery. You always expect to find some variation, and in many cases this is a good thing, as it shows the health system is responding to the higher or lower health needs or preferences of people in different areas. But these very large differences we are seeing suggest some of this variation may be unwarranted.
‘The goal is appropriate care – the right care for the right person, at the right time. The Atlas focuses on areas of health care in which the thinking about what treatments work best has changed considerably in recent years, either because better treatments have come along or because the evidence about existing treatments has shifted. The Atlas helps us to see which local areas could benefit further from these newer and better approaches.’
The second Atlas includes case studies showcasing the good work already being done to improve care nationally.