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July 2009 – June 2012

Returns to acute care and mortality for five clinical conditions2

Condition This period

July 2000 – June 2003 July 2003 – June 2006 July 2006 – June 2009 July 2009 – June 2012

Average length of stay (days)3

Space for chart

Pneumonia

Hip fracture surgery

Concord Hospital

Time series

Acute myocardial

infarction (AMI)

Ischaemic stroke

Congestive heart

failure (CHF)

05

1015202530354045

Length

of

sta

y

Acute myocardial infarction

Ischaemic stroke Congestive heart failure Pneumonia Hip fracture surgery

Range across NSW hospitals NSW This hospital

Higher than expected No different than expected Lower than expected Not reported

This profile reports risk-standardised readmission ratios (RSRRs) and risk-standardised mortality ratios (RSMRs). The

ratios take into account differences across hospitals in terms of case mix and volumes of patients, and results are

reported as either: higher than expected; no different than expected; or lower than expected. The performance dashboard

below summarises ratio results for five conditions over a 12 year period together with length of stay information for July

2009 – June 2012. Subsequent pages provide information to support interpretation of the RSRR. Readmissions are

defined as returns to acute care1 and results describe the age profile and comorbidity profile of patients; the number who

returned to acute care within 30 days of discharge; and reasons, location and timing of returns to acute care.

RSRR

RSMR

RSRR

RSMR

RSRR

RSRR

RSMR

RSRR

RSMR

RSRR

RSMR

RSRR

RSMR

RSRR

RSRR

RSMR

RSRR

RSMR

Bureau of Health Information | Concord Hospital 1

NOTES:

1. For patients whose acute hospitalisation ends with discharge home, a return to acute care involves readmission to hospital; while

for patients whose acute hospitalisation ends with a 'discharge' to non-acute care, a return involves a move back into an acute

care setting regardless of whether they physically left the hospital.

2. The “Not reported” category is used when there were fewer than 50 index cases admitted in the time period. Risk-standardised

mortality ratios have been taken from the BHI publication The Insights Series: 30-day mortality following hospitalisation, five

clinical conditions, NSW, July 2009 – 2012 and further information about this measure can be found there. RSRR outlier status is

determined using funnel plot control limits of 95% and 99.8%.

3. For calculation of average length of stay, index admissions that were transferred in from, or transferred out to, another acute care

hospital were excluded. Unreasonably long episodes are trimmed on the basis of the Diagnosis Related Group (DRG) of the

episode. The trim point is the third quartile plus 1.5 x the interquartile range of all in-scope episodes in each DRG.

4. Discharge destinations are based on the mode of separation of the index case. For episodes coded as 'Discharged by hospital' or

'Discharged on leave', patients are considered to be destined for their place of usual residence. All other modes of separation are

deemed to indicate a discharge destination other than a patient‟s place of usual residence.

5. Age of the patient at admission for the index case is used. Percentages may not add to 100% due to rounding.

6. Comorbidities are identified from the hospital discharge records using the Elixhauser comorbidity set (plus dementia) with a one

year look-back from the admission date of the index case. Percentage labels have been rounded to the nearest integer.

7. Results for hospitals with <1 expected return to acute care (readmission) within 30 days are not shown.

8. Peer hospitals are identified according to the NSW Ministry of Health‟s peer grouping as of 30 June 2011. Hospitals with fewer

than 50 index cases are not shown.

9. Hospitals are classified as urban and regional/rural using the geocoded address of the hospital assigned to ABS statistical areas

(SA2) and the Australian remoteness index for areas. Further information can be found in this report's Spotlight on Measurement

companion publication.

10.Reasons for return to acute care are classified according to a draft specification made available to the BHI by the Australian

Institute of Health and Welfare. Principal diagnoses for the return to acute care episode, are stratified as: the same as the index

hospitalisation; related to that of the index hospitalisation; potentially related to hospital care (i.e. complications and adverse

events) using various time horizons; and, other reasons. Percentages may not add to 100% due to rounding.

Further information can be found in this report's Spotlight on Measurement companion publication.

Data source: SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health.

Bureau of Health Information | Concord Hospital | July 2009 – June 2012 2

This hospital NSW

748 27,325

6.6 6.0

171 11,648

633 24,132

115 3,193

*Age was a significant factor in the final model of 30-day returns to acute care following an index hospitalisation for AMI.

Presence of factors associated with 30-day AMI return to acute care6

space for chart

30-day return to acute care following hospitalisation for AMI

Patient cohort, index cases3,4

Total AMI index cases

Age profile for index cases (years)* 5

Other

Home

Average length of stay (days)

Patients transferred in from acute care in another hospital

Discharge destination

space for chart5

7

33

33

22

21

24

23

16

16

0 10 20 30 40 50 60 70 80 90 100

% index cases

15–44 45–64 65–74 75–84 85+

This hospital

NSW

26

18

18

14

8

7

6

7

3

3

2

1

1

1

27

20

16

15

11

10

7

7

4

3

2

2

1

<0.5

0 5 10 15 20 25 30

Cardiac arrhythmia

Congestive heart failure

Diabetes, complicated

Fluid and electrolyte disorders

Renal failure

History of AMI

Chronic pulmonary disease

Valvular disease

Peripheral vascular disorders

Alcohol abuse/drug abuse/psychoses

Solid tumour without metastasis

Depression

Hypothyroidism

Peptic ulcer disease, excl. bleeding

% of index cases

This hospital NSW


Hospital level AMI RSRR by number of expected returns to acute care (readmissions)7

space for chart

space for chart


Observed and expected 30-day returns to acute care, grouped with peers8

Hospital-specific RSRRs report the ratio of actual or „observed‟ number of returns to acute care to the „expected‟

number of returns. A competing risk regression model draws on the NSW patient population‟s characteristics and

outcomes to estimate the expected number of returns for each hospital, given the characteristics of its patients. An

RSRR less than 1.0 indicates lower-than-expected returns to acute care, and a ratio higher than 1.0 indicates higher-

than-expected returns. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 95% and

99.8% control limits around the NSW rate are used to identify outliers.

0 50 100 150 200 250 300 350

Calvary Mater Newcastle

Bankstown / Lidcombe

St Vincent's

Concord

Gosford

Royal North Shore

Nepean

Prince of Wales

St George

Wollongong

John Hunter

Royal Prince Alfred

Liverpool

Westmead

Number of 30-day returns to acute care

This hospital,observed returns

Peer group hospital,observed returns

Expected returns to acutecare (based on model)

RSRR 0.81

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)

Expected number of returns to acute care (readmissions) within 30 days

This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

101 4,453

77 3,042

24 1,411

21

3

0

Distribution of reasons for returns to acute care

Number of, and reasons for, returns to acute care following hospitalisation for AMI, by days post discharge

Returned to a different hospital

Of these:

To an urban public hospital


Location of returns to acute care9

Returned to the hospital where acute care was completed

Total returns to acute care following AMI index hospitalisation

To a private hospital

Reasons for and time to returns to acute care10

space for chart

space for chart

To a regional or rural public hospital

14

11

33

36

8

11

8

1

20

18

18

24

0 10 20 30 40 50 60 70 80 90 100

% returns to acute care

Principal diagnosis Condition related to principal diagnosis Potentially related to hospital care (relevant at any time)

Potentially related to hospital care (time sensitive, ≤ 7 days post discharge)

Potentially related to hospital care (time sensitive, 8–30 days post discharge)

Other condition

This hospital

NSW

5 3

1 2

13 15

7

1

3 3

3

2

1

10

2

6

9

5

8

2

0

5

10

15

20

25

30

35

40

1–7 days 8–14 days 15–21 days 22–30 days

Num

ber

of re

turn

s to a

cute

care

Days post discharge


This hospital NSW

470 12,776

10.2 9.5

30 1,713

237 6,772

233 6,004

space for chart

*Age was not a significant factor in the final model of 30-day returns to acute care following an index hospitalisation for ischaemic

stroke.


Home

Other

Age profile for index cases (years)* 5

space for chart

Presence of factors associated with 30-day ischaemic stroke return to acute care6


30-day return to acute care following hospitalisation for ischaemic stroke


Total ischaemic stroke index cases


4

3

20

18

23

21

32

34

21

24

0 10 20 30 40 50 60 70 80 90 100

% index cases

15–44 45–64 65–74 75–84 85+

This hospital

NSW

35

19

6

8

6

4

1

0

32

15

7

6

4

4

1

<0.5

0 5 10 15 20 25 30 35 40

Cardiac arrhythmia


Renal failure

Dementia

Weight loss


Metastatic cancer

AIDS/HIV

% of index cases

This hospital NSW


space for chart








Hospital level ischaemic stroke RSRR by number of expected returns to acute care (readmissions)7

space for chart



St Vincent's

Prince of Wales

Concord


Nepean

Royal North Shore

Royal Prince Alfred

Gosford

Westmead

John Hunter

Wollongong

St George

Liverpool

0 20 40 60 80 100 120





RSRR 0.90

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

43 1,321

33 1,022

10 299

10

0

0


space for chart

Number of, and reasons for, returns to acute care following hospitalisation for ischaemic stroke, by days post discharge

Of these:





space for chart





Total returns to acute care following ischaemic stroke index hospitalisation

19

7

10

7

21

30

7

12

15

23

28

21

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

1 2

1

1

1 4

3 5 1

5

5

1 4

1

4

3 1

0

2

4

6

8

10

12

14

16


Num

ber

of re

turn

s to a

cute

care

Days post discharge


This hospital NSW

889 29,961

8.2 6.6

31 2,820

707 26,099

182 3,862

space for chart

*Age was a significant factor in the final model of 30-day returns to acute care following an index hospitalisation for congestive heart

failure.


Home

Other

Age profile for index cases (years)*5

space for chart

Presence of factors associated with 30-day congestive heart failure return to acute care6


30-day return to acute care following hospitalisation for congestive heart failure


Total congestive heart failure index cases


1

1

11

8

18

16

37

40

32

34

0 10 20 30 40 50 60 70 80 90 100

% index cases

15–44 45–64 65–74 75–84 85+

This hospital

NSW

62

40

39

32

30

16

32

13

11

52

38

30

27

22

21

16

8

8

0 10 20 30 40 50 60 70

Cardiac arrhythmia

History of congestive heart failure


Renal failure



Valvular disease

Coagulopathy

Deficiency anaemia

% of index cases

This hospital NSW


space for chart








Hospital level congestive heart failure RSRR by number of expected returns to acute care (readmissions)7

space for chart


Sydney/Sydney Eye


St Vincent's

Gosford

Royal North Shore

Wollongong

Nepean

Concord

Prince of Wales


John Hunter

Royal Prince Alfred

St George

Liverpool

Westmead

0 50 100 150 200 250 300 350





RSRR 0.93

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

199 6,850

155 5,608

44 1,242

41

2

1


Number of, and reasons for, returns to acute care following hospitalisation for congestive heart failure, by days post discharge

space for chart

Of these:





space for chart





Total returns to acute care following congestive heart failure index hospitalisation

37

40

11

8

6

7

7

13

19

16

19

17

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

22 22 15

21

5 3

4

4

6

1 6

1

25

15

8 8

11

8

7 7

0

10

20

30

40

50

60

70

80


Num

ber

of re

turn

s to a

cute

care

Days post discharge


This hospital NSW

892 42,777

7.6 6.1

46 4,358

700 37,971

192 4,806

space for chart

*Age and sex were significant factors in the final model of 30-day return to acute care following an index hospitalisation for pneumonia.

The percentage of index hospitalisations that were female patients at this hospital was 47% compared to 48% for NSW.


Home

Other


space for chart

Presence of factors associated with 30-day pneumonia return to acute care6


30-day return to acute care following hospitalisation for pneumonia


Total pneumonia index cases


15

11

22

17

18

18

26

28

19

26

0 10 20 30 40 50 60 70 80 90 100

% index cases

18–44 45–64 65–74 75–84 85+

This hospital

NSW

36

18

26

28

17

10

12

12

7

4

10

6

4

4

4

3

2

2

3

24

20

20

19

14

10

9

6

6

5

4

4

3

3

3

3

3

2

1

0 5 10 15 20 25 30 35 40



Cardiac arrhythmia

Hypertension, uncompl. or compl.

Congestive heart failure

History of pneumonia

Renal failure

Weight loss


Alcohol abuse/drug abuse/psychoses

Coagulopathy

Other neurological disorders

Pulmonary circulation disorders

Deficiency anaemia

Metastatic cancer

Depression

Diabetes, uncomplicated

Liver disease

Lymphoma

% of index cases

This hospital NSW


space for chart








Hospital level pneumonia RSRR by number of expected returns to acute care (readmissions)7

space for chart


0 50 100 150 200 250 300

Sydney/Sydney Eye


St Vincent's

Royal North Shore

John Hunter


Gosford

Prince of Wales

Concord

Wollongong

Royal Prince Alfred

Nepean

Liverpool

St George

Westmead





RSRR 0.93

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

123 5,412

101 4,323

22 1,089

20

2

0


Number of, and reasons for, returns to acute care following hospitalisation for pneumonia, by days post discharge

space for chart

Of these:





space for chart




Total returns to acute care following pneumonia index hospitalisation


19

22

17

22

8

9

9

3

17

18

30

26

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

15

5 3 4

9

7 8

3

1

5

2

3

4

8

10

4

6 12

4

10

0

5

10

15

20

25

30

35

40


Num

ber

of

retu

rns to a

cute

care

Days post discharge


This hospital NSW

462 14,035

12.3 12.1

22 3,141

56 4,888

406 9,147

space for chart

*Age and sex were significant factors in the final model of 30-day return to acute care following an index hospitalisation for hip fracture

surgery. The percentage of index hospitalisations that were female patients at this hospital was 73% compared to 73% for NSW.


Home

Other


space for chart

Presence of factors associated with 30-day hip fracture surgery return to acute care6


30-day return to acute care following hospitalisation for hip fracture surgery


Total hip fracture surgery index cases


6

5

12

8

35

35

48

53

0 10 20 30 40 50 60 70 80 90 100

% index cases

50–64 65–74 75–84 85+

This hospital

NSW

37

30

8

12

7

6

3

2

1

29

24

8

8

7

4

3

2

1

0 5 10 15 20 25 30 35 40


Dementia

Renal failure



Coagulopathy


Diabetes, uncomplicated

Liver disease

% of index cases

This hospital NSW


space for chart








Hospital level hip fracture surgery RSRR by number of expected returns to acute care (readmissions)7

space for chart


0 20 40 60 80 100 120

St Vincent's

Royal Prince Alfred

Liverpool


Prince of Wales

Gosford

Concord

Royal North Shore

Westmead

St George

Wollongong

John Hunter

Nepean





RSRR 1.21

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

60 1,396

51 1,036

9 360

9

0

0


Number of, and reasons for, returns to acute care following hospitalisation for hip fracture surgery, by days post discharge

space for chart

Of these:





space for chart





Total returns to acute care following hip fracture surgery index hospitalisation

6

7

16

13

8

13

13

15

26

23

32

28

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

1 1 1 1

5

1 2

1

2 2

3

9

7

2 5

6

1

2

8

0

5

10

15

20

25


Num

ber

of re

turn

s to a

cute

care

Days post discharge


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