The Second Australian Atlas of Healthcare Variation

The Second Australian Atlas of Healthcare Variation (second Atlas) paints a picture of marked variation in the use of 18 clinical areas (hospitalisations, surgical procedures and complications) across Australia.

This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live.  As well, this Atlas identifies specific achievable actions for exploration and quality improvement.

The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.

Priority areas for investigation and action arising from the second Atlas include use of:

  • Hysterectomy and endometrial ablation
  • Chronic conditions (COPD, diabetes complications)
  • Knee replacement.

Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Healthcare Variation – what does it tell us

Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.

View the second Atlas

The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.

Key findings and recommendations for action are available here.

View the maps and download the data using the interactive platform.

What does the Atlas measure?

The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia.  The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.

The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.

Who has developed the second Atlas?

The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.

The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.

Features of the second Atlas include:

  • Greater involvement of clinicians during all stages of development
  • Analysis of data by Aboriginal and Torres Strait Islander status
  • Analysis of data by patient funding status (public or private).

Table of Contents

Chapter 1 Chronic disease and infection: potentially preventable hospitalisations

1.1 Chronic obstructive pulmonary disease (COPD)
1.2 Heart failure
1.3 Cellulitis
1.4 Kidney and urinary tract infections
1.5 Diabetes complications

Chapter 2 Cardiovascular conditions

2.1 Acute myocardial infarction admissions
2.2 Atrial fibrillation

Chapter 3 Women’s health and maternity

3.1 Hysterectomy
3.2 Endometrial ablation
3.3 Cervical loop excision or cervical laser ablation
3.4 Caesarean section, ages 20 to 34 years
3.5 Third- and fourth-degree perineal tear

Chapter 4 Surgical interventions

4.1 Knee replacement
4.2 Lumbar spinal decompression
4.3 Lumbar spinal fusion
4.4 Laparoscopic cholecystectomy
4.5 Appendicectomy
4.6 Cataract surgery
Technical Supplement
About the Atlas
Glossary

Australian Atlas of Healthcare Variation data set specifications are available at http://meteor.aihw.gov.au/content/index.phtml/itemId/674758