Measure 2.1
- Objective area
- Safe
- Outcome area
- Avoidance of overtreatment
- Measure
- Proportion of people with life-limiting illnesses who received potentially non-beneficial treatments at the end of life.
- Population
- People with life-limiting illnesses who died within the reference year.
- Numerator
- Number of people with life-limiting illnesses who died within the reference year and had at least one record of receiving a potentially non-beneficial treatment as an inpatient of a public hospital at the end of life. This includes cardiopulmonary resuscitation, intravenous feeding, mechanical ventilation, or initiation of chemotherapy or dialysis in the last 30 days of life (0 to 29 days inclusive), or receipt of chemotherapy in the last 15 days of life (0 to 14 days inclusive).
- Denominator
- Number of people with life-limiting illnesses who died within the reference year.
- Computation
- (Numerator ÷ Denominator) x 100
- Disaggregation
- State/Territory, Age, Sex, Socioeconomic area, Remoteness area, Cause of death, Potentially non-beneficial treatment. For more information see Data sources.
- Source
- AIHW National Integrated Health Service Information (NIHSI) linked data asset.
- Definitions
People with life-limiting illnesses – all people who died in the reference year and had an underlying cause of death amenable to palliative care based on Murtagh et al. (2013) ) as shown in Table 2.1.2.
Table 2.1.2: Causes of death amenable to palliative care based on Murtagh et al. (2013) Cause of death ICD-10 codes Neoplasm (excludes benign neoplasms) C00-C97 Heart disease I00-I52 Cerebrovascular disease I60-I69 Renal disease N17, N18, N28 Liver disease K70-K77 Respiratory disease J06-J18, J20-J22, J40-J47, J96 Neurodegenerative disease G10, G20, G35, G122, G903, G231 Alzheimer’s disease F01, F03 Dementia G30 Senility R54 HIV/AIDS B20-B24 Potentially non-beneficial treatment – A treatment or intervention that is unlikely to prolong life or provide comfort at the end of life including the following treatments from the Australian Classification of Health Interventions Code:
Non-beneficial treatment Block description Block extension Block ext. description Chemotherapy
(receipt in the last 15 days of life or initiation in the last 30 days of life)Administration of pharmacological agent, antineoplastic agent 96196-00 Intra-arterial 96197-00 Intramuscular 96198-00 Intrathecal 96199-00 Intravenous 96200-00 Subcutaneous 96201-00 Intracavitary 96202-00 Enteral 96203-00 Oral 96205-00 Other 96209-00 Loading of drug delivery device, antineoplastic agent Cardiopulmonary resuscitation
(in the last 30 days of life)Therapeutic interventions on cardiovascular system 92052-00 Cardiopulmonary resuscitation Artificial nutrition
(in the last 30 days of life)Administration of pharmacological agent, nutritional substance 96196-07 Intra-arterial 96197-07 Intramuscular 96198-07 Intrathecal 96199-07 Intravenous 96200-07 Subcutaneous 96201-07 Intracavitary 96202-07 Enteral 96203-07 Oral 96205-07 Other 96209-07 Loading of drug delivery device, nutritional substance Mechanical ventilation
(in the last 30 days of life)Management of continuous ventilatory support 13882-00 24 hours or less 13882-01 More than 24 but less than 96 hours 13882-02 96 hours or more Management of non-invasive ventilatory support 92209-00 24 hours or less 92209-01 More than 24 but less than 96 hours 92209-02 96 hours or more Dialysis
(initiation in the last 30 days of life)Peritoneal dialysis 13100-06 Peritoneal dialysis, short term 13100-07 Intermittent peritoneal dialysis, long term 13100-08 Continuous peritoneal dialysis, long term Haemodialysis 13100-00 Haemodialysis 13100-01 Intermittent haemofiltration 13100-02 Continuous haemofiltration 13100-03 Intermittent haemodiafiltration 13100-04 Continuous haemodiafiltration 13100-05 Haemoperfusion - Notes
- Identifying overtreatment using administrative data is challenging as the data do not capture the nuance at the time of treating, such as treatment appropriateness, care intent, life expectancy, patient functionality, patient and family preferences, and physician-patient interactions. Furthermore, end of life trajectories are inherently uncertain. It can be very difficult for clinicians to predict time to death, and they may not know that a treatment is non-beneficial at the time of treating. Given the uncertainty of the circumstances at the time of treating and the social and ethical pressures that exist, a certain level of potentially non-beneficial treatments will likely always be present but reducing their occurrence should be an aim of improving the quality of palliative care in Australia.
- There is currently no complete national data on receipt of potentially non-beneficial treatments for people with life-limiting illnesses. The NIHSI linked data asset is the only available national data that identifies inpatient procedures and cause-specific outcomes. However, this data collection does not present a complete picture of health service use, as it excludes hospital data from Western Australia and the Northern Territory, and all private hospitals nationally for this analysis, for the reference period. It omits services received by patients in specialised palliative care units in private hospitals/ facilities. For more information see Data sources.
AIHW (2020-21) National Integrated Health Services Information, aihw.gov.au, accessed 22 February 2024
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