Non-admitted patient palliative care
Every year many Australians receive services as an outpatient in non-admitted patient clinics, such as hospital outpatient clinics, community-based clinics and patients’ homes. These services are often associated with an emergency or admitted patient episode for which diagnostic or follow-up care is required without needing the person to be admitted to hospital. The types of care include consultations with specialist medical practitioners, the provision of diagnostic or other procedures, and allied health or clinical nurse specialist services.
In this report, non-admitted patient service event is used to count health care service delivered to patients in the non-admitted sector of the public hospital system. This chapter provides information related to palliative care-related service events – that is non-admitted patient care service events related to palliative care – and the distribution and characteristics of these service events in 2022–23.
Palliative care and end-of-life care is increasingly be delivered outside the specialist-admitted palliative care settings. This new chapter on palliative care delivered in non-admitted settings helps to address a key data gap on receipt of community-based palliative care services, which is one of the priorities identified in the report Palliative Care and End-of-Life Care Information Priorities (PDF 892KB).
Note that due to the changing scope of the non-admitted patient care data collections, time series data are not provided as they are not comparable. Further information about how these palliative care-related service events are identified through non-admitted patient care data is provided in Data source.
The information in this chapter was last updated in October 2024.
This chapter presents information on non-admitted patient service events for palliative care, sourced from the Non-admitted Patient Care Data Collections, which include both aggregated clinic-level and episode-level details. This chapter only reports the episode-level data for palliative care-related service events, which is based on data in the National Non-admitted Patient Database (NNAP(el)D). The NNAP(el)D is collected under the Non-admitted patient National Best Endeavours Data Set (NAP NBEDS) and includes information on:
- type of outpatient clinic
- type of care provided
- selected patient characteristics
- selected characteristics for the services events, such as service request source, delivery mode and setting
- funding source of service events.
Note that for NNAP(el)D, counts represent each service event, not each patient. Therefore, patients who receive more than one non-admitted patient service event in the reporting period will have more than one record in the NNAP(el)D.
The scope of NAP NBEDS is non-admitted patient service events involving non-admitted patients provided by:
- public hospitals
- Local Hospital Networks
- other public hospital services that are managed by a state or territory health authority and are included in the General list of in-scope public hospital services, which have been developed under the National Health Reform Agreement (2011).
The scope of NAP NBEDS excludes:
- non-admitted services provided to admitted patients and emergency department patients
- the community mental health care services
- the service events which are delivered as non-clinical care (such as home-based care).
For this NAP NBEDS, a non-admitted service is a specialty unit or organisational arrangement under which a jurisdictional health authority, Local Hospital Network or public hospital provides non-admitted services. A Local Health Network are entities recognised as such by the relevant state or territory health authority.
The Tier 2 Non-Admitted Services Classification (Tier 2) categorises a hospital’s non-admitted services into classes which are generally based on the nature of the service provided and the type of clinician providing the service. Tier 2 is classified to one of the groups below based on the predominant nature of the service provided:
- Procedures: used to capture clinics where healthcare professionals provide procedural based health services. These may include COVID-19 vaccination, treatment chemotherapy, radiation therapy, renal dialysis and so on.
- Medical consultation services: used to capture clinics where the nature of the medical consultation means it is typically provided by a medical practitioner, a nurse practitioner or an endorsed midwife practitioner. In medical clinics, it is assumed that there may also be input from allied health personnel and/or clinical nurse specialists. These services include COVID-19 response, pain management, general practice and primary care, paediatric medicine and surgery, and so on.
- Diagnostic services: used to capture clinics that provide diagnostic services as inputs to the healthcare services of other non-admitted clinics. The services include COVID-19 response diagnostics, Medical Resonance Imaging (MRI), Computerised Tomography (CT), mammography screening, clinical measurement and so on.
- Allied health or clinical nurse specialist intervention services: used to capture clinics where there are allied health personnel and/or clinical nurse specialists providing the majority of services in a clinic. The services include COVID-19 response, aged care assessment, primary health care, rehabilitation, social work and so on.
A full list of services in each Tier 2 class in the reporting period can be found in the Tier 2 National Index 2022–23.
Patient episodes are then allocated to classes based on the predominant specialisation, which may be formed around the clinician, patient condition, patient population group or type of care.
In 2022–23, 83% of non-admitted patient service events were recorded at the episode-level. The data presented in this report therefore is likely to underestimate the counts of all non-admitted patient service events for palliative-care delivered in Australia.
For more information, see Data source.
Box 1: Identifying palliative care in non-admitted patient care data
People with life-limiting illnesses may require care in a hospital setting, such as a hospital ward (specialist palliative care ward or other areas of the hospital), an emergency department or an outpatient clinic.
This chapter only covers outpatient care for non-admitted patients, who do not undergo a hospital’s formal admission process and have received the non-admitted care provided by public hospitals, Local Hospital Networks or other public hospital services that are managed by a state or territory health authority and are included in the General list of in-scope public hospital services, which have been developed under the National Health Reform Agreement (2011).
Palliative care-related service events refer to non-admitted patient service events related to palliative care. These service events must contain therapeutic/clinical content and result in a dated entry in the patient's medical record. Palliative care-related service events can be divided into 3 groups depending on how they are identified in the non-admitted patient care data (by care type or by Tier 2 clinics type):
- Primary palliative care service events: non-admitted patient care with a recorded care type of palliative care. These services may include medical consultations for palliative care, developmental disabilities, general medicine, medical and radiation oncology; allied health and/or clinical nurse specialist interventions for palliative care, nutrition/dietetics, Geriatric Evaluation and Management (GEM) and oncology; and treatment chemotherapy, treatment radiation therapy, minor surgical and minor medical procedures.
- Medical consultations for palliative care: non-admitted patient care with a recorded Tier 2 as palliative care in medical consultations. These consultations can be categorised as palliative care, rehabilitation care or other care by care type.
- Allied health and/or clinical nurse specialist interventions for palliative care: non-admitted patient care recorded as Tier 2 palliative care in allied health and/or clinical nurse specialist interventions. These interventions can be categorised as palliative care or rehabilitation care by care type.
Note, there is no palliative care class in non-admitted services classified as procedures and diagnostic services. Also noting that a palliative care-related service event can be identified as palliative care by care type, by Tier 2 clinics type, or both.
For more information, see Data source.
Key points
In 2022–23, among the 882,000 palliative care-related service events recorded at episode-level:
- slightly over half (51% or 453,000) were provided to males
- 73% were for people aged 65 and over, 15% were for people aged 55–64, and 12% were for people aged under 55
- 98% were delivered as individual sessions and the remaining 2% were delivered as group sessions for 2 or more patients
- 28% of referrals were from the same hospital where the service was provided, about 1 in 9 each were from general practice (12%) and other hospital (11%), and 5% were informal self-referral for an unplanned 'walk-in' service
- about 7 in 10 (68%) were delivered off the hospital campus of the healthcare provider (for example, in the person’s home), and 3 in 10 (30%) were delivered on the hospital campus of the healthcare provider
- about half were delivered in person (48%), and by telephone (47%)
- 98% were provided by a single healthcare provider and the remaining 2% were provided by multiple healthcare providers (either individually or jointly)
- 96% were funded through the health service budget, and 1.7% were funded under the Medicare Benefits Schedule.
| Key concept | Description |
|---|---|
| Allied health and/or clinical nurse specialist intervention for palliative care | Non-admitted patient care service event with a recorded Tier 2 non-admitted service type as palliative care in allied health and/or clinical nurse specialist interventions. |
| Care type | The type of care provided at a non-admitted patient service event. It can be assigned as:
|
| Medical consultation for palliative care | Non-admitted patient care service event with a recorded Tier 2 non-admitted service type as palliative care in medical consultations. |
| Non-admitted care | Care provided to a patient who has not undergone a hospital’s formal admission process. In this report, the care includes non-admitted patient service events involving non-admitted patients provided by:
Care excludes:
|
| Non-admitted patient | A patient who does not undergo a hospital’s formal admission process. In this report, the non-admitted patients only include those who have received the non-admitted care provided by:
|
| Non-admitted patient care service event | An interaction between one or more health-care provider(s) with one non-admitted patient, which must contain therapeutic/clinical content and result in a dated entry in the patient's medical record. See METEOR identifier: 652089. |
| Palliative care-related service event | Non-admitted patient care service event where the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness. It must contain therapeutic/clinical content and result in a dated entry in the patient's medical record. |
| Primary palliative care service event | Non-admitted patient care service event with a recorded care type of palliative care. |