National palliative care measures

This section describes the classification systems and methodology used in the National Palliative Care Measures web report.

Australian Statistical Geographical Standard for Remoteness Areas

The Australian Statistical Geographical Standard (ASGS) for Remoteness Areas was developed by the Australian Bureau of Statistics (ABS) to collect and disseminate geographically classified statistics (ABS 2011; ABS 2016; ABS 2021).

The ASGS’s remoteness structure categorises geographical areas in Australia into five remoteness areas:

• Major cities
• Inner regional
• Outer regional
• Remote
• Very remote.

The ABS website includes detailed information on ASGS, including the key changes made between each edition.

Further information on how Remoteness Areas were assigned can be found in the Data sources section. 

Index of Relative Socio-economic Disadvantage

The Index of Relative Socio-economic Disadvantage (IRSD) is 1 of 4 Socio-Economic Indexes for Areas (SEIFA) developed by the ABS (ABS 2018). The IRSD represents the socioeconomic position of Australian communities by measuring aspects of disadvantage, such as low income, low educational attainment, high unemployment, and jobs in relatively unskilled occupations. Areas are then ranked according to their level of disadvantage.

When the IRSD is used in this report, people living in the 20% of areas with the greatest overall level of disadvantage are described as living in the ‘lowest socioeconomic areas’. The 20% of people at the other end of the scale – those living in areas with the least overall level of disadvantage – are described as living in the ‘highest socioeconomic areas’.

It is important to note that the IRSD reflects the overall or average socioeconomic position of the population of an area; it does not show how individuals living in the same area might differ from each other in their socioeconomic position.

International Statistical Classification of Diseases and Related Health Problems

The International Statistical Classification of Diseases and Related Health Problems (ICD), which was developed by the World Health Organization (WHO), is the international standard for coding morbidity and mortality statistics. It was designed to promote international comparability in collecting, processing, classifying and presenting these statistics. The ICD is periodically reviewed to reflect changes in clinical and research settings (WHO 2022).

The version currently used in Australia to code causes of death, ICD-10 (WHO 1992), was endorsed in May 1990 and officially came into use in WHO member states from 1994. The 11th revision of the ICD-10 was released in June 2018. Further information on the ICD is available from the WHO website.

ICD-10-AM

Diagnosis, procedure and external cause hospital data for 2021–22 were reported to the NHMD by all states and territories using the 11th edition of the Australian Modification of ICD-10, referred to as the ICD-10-AM. ICD-10-AM, is based on ICD-10 (NCCH 2013). ICD-10 was modified for the Australian setting by the National Centre for Classification in Health (NCCH) to make it more relevant to Australian clinical practice. Compatibility with ICD-10 at the higher levels (that is, up to 4-character codes) of the classification has been maintained. ICD-10-AM has been used to classify diagnoses in admitted patient hospital records in all Australian states and territories since 1999–2000 (AIHW 2000).

The ICD-10-AM disease classification is hierarchical – a small number of summary disease chapters are divided into a large number of more specific disease groupings (represented by 3-character codes). Most of the 3-character disease groupings can be divided into an even larger number of very specific disease categories represented by 4-character and 5-character codes (see Measures 2.1, 4.1 and 4.2a in the Data dictionary). 

Methodology for reporting on the progress of measures over time

To determine the 'progress status' of each measure, statistical testing was used to understand if the measure had significantly changed over time. Univariable logistic regression modelling was used to test the direction and statistical significance (p<0.05) of the change in each measure from baseline to the latest available data. Statistical testing was performed on summary data only for measures 1.1, 1.2, 3.2, and 5.1a. 

The 'Status key' for the relevant icon in the report can be summarised as follows: 

Progress: The change in the measure from baseline to latest available data was statistically significant (p<0.05) and moving in the desired direction. 

No change: Any change in the measure from baseline to latest available data was not statistically significant (p<0.05) . 

Regress: The change in the measure from baseline to latest available data was statistically significant (p<0.05) and moving in the opposite direction to what is desired. 

Status not yet known: Insufficient data currently available.