The Aged Care Funding Instrument (ACFI) consists of 12 questions about a person’s assessed care needs, and two diagnostic sections: Mental and Behavioural Diagnosis and Medical Diagnosis. Medical diagnosis includes any disease or disorder, excluding the mental and behavioural disorders recorded in the ACFI Mental and Behavioural Diagnosis checklist. See the Aged Care Funding Instrument User Guide for a complete list of Mental and Behavioural Disorders. During the ACFI appraisal process, information is recorded on relevant mental and behavioural diagnoses and up to 3 other medical diagnoses relevant to a person’s care needs. Data in this report refers to the first listed condition only.
Conditions or complaints either coexisting with the principal diagnosis or arising during the episode of care. Additional diagnoses are recorded in accordance with ICD-10-AM Australian Coding Standards.
Patients who undergo a hospital's formal admission process to receive treatment and/or care.
Anticipatory care is care that anticipates the needs of the patient and carer in order to avoid an increase in the problem or need. The PCOC anticipatory care benchmarks relate to patients who have absent or mild symptoms/problems at the start of a phase of palliative care. To meet this benchmark, 90% of these phases must end with absent or mild symptom/problem scores.
Attendance at person’s place of residence
A professional attendance in the patient’s home, residential aged care facility (other than consulting rooms within a residential aged care facility), or other institution by a specialist, or consultant physician, in the speciality of palliative medicine following referral by a referring practitioner.
Average length of stay
The length of stay for an overnight patient is calculated by subtracting the date the patient is admitted from the date of separation and deducting any days the patient was ‘on leave’. Average length of stay refers to the average number of patient days for admitted patient episodes. Patients admitted and separated on the same day are allocated a length of stay of 1 day.
A predefined level of achievement. In PCOC, the outcomes of groups of palliative care patients (e.g. within a service/state /nationally) are aggregated and compared to this level. The PCOC benchmarks are aspirational and reflect good practice (top 20% percentile). The PCOC benchmarks are the same regardless of sector (public/private), location or role.
Bettering the Evaluation and Care of Health (BEACH)
The BEACH program, which began in April 1998, is a continuous national cross-sectional study of general practitioner (GP) activity in Australia.
Care type refers to the overall nature of a clinical service provided to an admitted patient during an episode of care. Examples of care types are Acute care, Rehabilitation care, Palliative care and Geriatric evaluation and management.
Case-mix adjusted outcome measure
This measures the mean change in symptoms, after adjusting for both phase and the symptom score at the start of each phase. This measure allows comparison of change in symptom and problem scores for ‘like’ patients. A positive score indicates that a service is achieving above the baseline national average, and a negative score indicates that it is below the baseline national average.
PCOC currently reports on 8 case-mix adjusted outcomes: patient-reported distress regarding pain, bowel problems, nausea and breathing problems; and clinician-reported symptom severity regarding pain, other symptoms, psychological/spiritual problems, and family/carer problems.
Total number of hours a practitioner spends working in the area of clinical practice; that is, the diagnosis, care and treatment, including recommended preventive action, of patients or clients.
Closed palliative care episode
A closed palliative care episode is one that includes an episode end date within the specified reporting period.
An episode ends or is closed when the following occurs: setting of palliative care changes (for example community to inpatient); principal clinical intent of the care changes and the patient is no longer receiving palliative care; the patient is formally separated from the service; or the patient dies.
Episodes where the patient received specialist palliative care in a community setting, often deemed as the patient’s ‘home’. This may be in their private residence, an aged care, mental health or disability residential facility or in a correctional facility.
Refers to occurrence of more than one condition/disorder at the same time.
The number of days between the start and end of an episode. This does not include leave days. Within the community setting, elapsed days do not reflect the number of times the palliative care team visited the patient.
An employed health professional is defined in this report as one who:
‘Employed’ people are referred to as the ‘workforce’ in this chapter. This includes only practitioners whose main speciality is palliative care and excludes those practitioners practising palliative care as a second or third speciality and those who were on extended leave for more than 3 months or who were not employed.
An Encounter refers to any professional interchange between a patient and a GP; it includes both face to face encounters and indirect encounters where there is no face to face meeting but where a service is provided (for example, a prescription or referral).
Exit from PRAC
An exit from permanent residential aged care (PRAC) occurs when a person who is a permanent resident stops receiving care from a particular PRAC service. The reasons for exit may include death, admission to hospital (excluding where the person is on hospital leave), return to community (such as to family or home), move to another residential aged care facility.
Full-time equivalent (FTE)
The number of standard-hour workloads worked by employed health professionals. The FTE is calculated by multiplying the number of employed professionals in a specific category by the average total hours worked by employed people in that category, and dividing by the number of hours in a standard working week. The standard working week is assumed to be 38 hours, equivalent to 1 FTE, for all practitioners with the exception of medical practitioners where it is assumed to be 40 hours.
The principal source of funds for an admitted patient episode (hospitalisation).
A medical practitioner who provides primary comprehensive and continuing care to patients and their families within the community.
A GP is a medical practitioner who is vocationally registered under Section 3F of the Health Insurance Act 1973 (Cwlth), and/or a Fellow of the Royal Australian College of General Practitioners, or a general practice registrar.
Hospice care unit
A type of specialist unit delivering palliative care services and can include both free-standing hospices and/or palliative care wards within a hospital.
Hospitalisation (or separation) refers to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay (beginning or ending in a change of type of care; for example, from Acute care to Rehabilitation).
A short-term stay in hospital of at least one night, which does not involve permanent discharge from permanent residential aged care.
Index of Relative Socio-Economic Disadvantage (IRSD)
One of four Socio-Economic Indexes for Areas (SEIFA) developed by the ABS (ABS 2008). 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. See Classifications for further information.
Inpatient episodes of care are those for which the intent of the admission was for the patient to be in a hospital or hospice overnight. This includes those patients who were admitted and died on the same day.
International Classification of Primary Care - Version 2 (ICPC-2) and ICPC-2 PLUS
the declared national standard in Australia for reporting of health data from general practice and patient self-reported health information. The following BEACH data elements are classified according to the ICPC-2:
Free text received from GPs is coded by trained secondary coders into a more detailed Australian interface terminology called ICPC-2 PLUS, each term of which is classified according to ICPC-2.
Length of stay
An overnight patient is calculated by subtracting the date the patient is admitted from the date of hospitalisation and deducting any days the patient was on leave.
MBS-subsidised palliative medicine specialist services
Palliative medicine is defined as ‘the specialist care of people with terminal illnesses and chronic health conditions in community, hospital and hospice settings. Palliative Medicine Physicians work collaboratively with a multidisciplinary team of health professionals to provide end of life care, provide relief from pain and symptoms of illness, and optimise the quality of life for a patient. Palliative medicine treats the physical aspects of illness, but also integrates psychological and spiritual facets of patient care’ (RACP 2020).
MBS-subsidised palliative medicine specialist services include services provided by a palliative medicine physician/specialist that are claimed under specialist palliative care MBS items on a fee-for-service basis that are partly or fully funded under the Australian Government’s Medicare program. These services cover patient attendances (or consultations) provided in different settings (hospital/consulting room or person’s place of residence), as well as services such as case conferencing. These item groups, along with the relevant MBS item numbers, are listed within the data sources page of this report.
The midpoint of a list of observations that have been ranked from the smallest to the largest.
In PCOC, an outcome measure is both a measure used to assess change in response to an intervention (e.g., palliative care), and is also used to refer to a standardised assessment tool or methodology designed to measure clinical concepts.
The PCOC outcome measures cover: time from the date the patient is ready for palliative care to palliative care episode start date (timeliness of palliative care); time that the patient spent in an unstable phase (responsiveness to urgent needs); change in patient symptoms and problems (responsiveness and appropriateness of the care plan in place).
Other end-of-life care hospitalisations
Defined, for the purposes of this report, as hospitalisations where a diagnosis of palliative care is recorded, but the primary clinical purpose of care is not palliation (care type not defined as palliative care) Further information can be found in the Identifying palliative care hospitalisations section.
An example is outcome measure ‘time in the unstable phase’ obtained using standardised methodology. The methodology is ‘unstable phase end date’ minus ‘unstable phase start date’, which measures the clinical concept of ‘responsiveness in managing patients with urgent needs’.
Palliative care episode
A palliative care episode is a period of contact between a patient and a service where palliative care is provided in a single setting (for example, inpatient setting). A palliative care episode starts on the date a comprehensive palliative care assessment is undertaken and documented.
An episode ends when one of the following occurs: setting of palliative care changes (for example community to inpatient); principal clinical intent of the care changes and the patient is no longer receiving palliative care; patient is formally separated from the service; or the patient dies.
Palliative care episodes, as used in this report, include both open episodes (those without an episode end date in the reporting period), and closed episodes (see glossary item ‘closed episodes’).
Palliative care patient
A person for whom a palliative care service accepts responsibility for assessment and/or treatment as evidenced by the existence of a medical record. Family and carers are included in this definition if interventions relating to them are recorded in the patient medical record.
Palliative care hospitalisations
Defined, for the purposes of this report, as hospitalisations where the primary clinical purpose of care is palliative care and care is provided in a palliative care unit or by a palliative care specialist (hospitalisations with a care type of palliative care). Further information can be found in the Identifying palliative care hospitalisations section.
Palliative care-related encounter
An encounter which includes GP-recorded terms relevant to one or more of the four ICPC-2 PLUS palliative care-related terms in one or more of the following three BEACH survey data elements:
The 4 ICPC-2 PLUS palliative care terms are:
Palliative care in permanent residential aged care (PRAC)
In this report, palliative care in permanent residential aged care (PRAC) is based on Aged Care Funding Instrument (ACFI) appraisals. Funding for palliative care under the ACFI is provided specifically for ‘end of life’ care, which takes place during the last days or week of a care recipient’s life, and where ongoing care will involve very intense clinical nursing and/or complex pain management in the residential care setting (DOH 2016).
Palliative care-related hospitalisations
Defined, for the purposes of this report, as those hospitalisations (episodes of admitted patient care) where palliative care was a component of the care provided during all or part of the episode, as evidenced by a code of palliative care for the ‘Care type’ and/or principal or additional diagnosis.
Palliative care-related hospitalisations are separated into two groups: palliative care and other end-of-life care.
Further information can be found in the Identifying palliative care hospitalisations section.
Palliative care-related prescriptions
Unless otherwise specified, palliative care-related prescriptions are defined in this report as medications listed in the PBS Palliative Care Schedule. The information on prescription medicines in this section has been sourced from the processing of the PBS/RPBS and refers to medications prescribed by approved prescribers and subsequently dispensed by approved suppliers (community pharmacies or eligible hospital pharmacies). Consequently, it is a count of medications dispensed rather than a count of prescriptions written by clinicians.
Palliative care nurse
The classification of nurses in Australia varies with the type of training they have undertaken. Nurse practitioners, registered nurses and enrolled nurses need to complete a variety of short or more comprehensive courses (including postgraduate certificates and Master’s degrees) to work in the field of palliative care, and postgraduate qualifications are generally required for nurses working in specialist palliative care services.
Palliative medicine physician/specialist
Medical practitioner who, in order to be eligible for payment of MBS subsidies for palliative care services, must be a Fellow of the Royal Australasian College of Physicians who has completed the College training program in palliative medicine, or a Fellow of the Australasian Chapter of Palliative Medicine, or a Fellow of both.
Under the PBS/RPBS, the cost of prescription medicines is subsidised by the Commonwealth government. Patients are classified as either general or concessional and are required to pay a patient co-payment towards the cost of their prescription according to their entitlement. At 1 January 2021 the co-payment was $41.30 (general) and $6.60 (concessional).
The occupancy of a hospital bed (or chair in the case of some same day patients) by an admitted patient for all or part of a day.
Data related to patient demographics
An admission to a permanent residential aged care service. This captures both new entries and transfers between services.
A person who is receiving long-term care in a permanent residential aged care (PRAC) service.
A phase level data items describe a palliative care patient’s stage of illness, functional impairment and their levels of pain and symptom distress. Five assessment tools are used to describe the clinical condition of a patient, which, in turn, contribute to a patient’s care plan. These assessment tools are phase of care, SAS, PCPSS, Australia-modified-Karnofsky Performance Status (AKPS), and Resource Utilisation Groups—Activities of Daily Living (RUG—ADL) which provide measures of quality and outcomes of care.
The PCOC analyses each service’s data and compares these with the national average. The items at the phase level are used to quantify patient outcomes and are the focus of the PCOC benchmarks. The four palliative care phases are:
Stable Phase Start: Patient problems and symptoms are adequately controlled by an established plan of care; further interventions to maintain symptom control and quality of life have been planned and the family/carer(s) situation is relatively stable and no new issues are apparent.
Stable Phase End: The needs of the patient and or family/carer(s) increase, requiring changes to the existing plan of care.
Unstable Phase Start: An urgent change in the plan of care or emergency treatment is required as the patient experiences a new problem that was not anticipated in the existing plan of care; and/or the patient experiences a rapid increase in the severity of a current problem; and/or the circumstances of the patient’s family/carer(s) change suddenly, impacting on patient care.
Unstable Phase End: The new plan of care is in place; it has been reviewed and no further changes to the care plan are required. This does not necessarily mean that the symptom crisis has fully resolved but there is a clear diagnosis and plan of care (that is, the patient is stable or deteriorating) and/or death is likely within days (that is, the patient is now terminal).
Deteriorating Phase Start: The care plan is addressing anticipated needs but requires periodic review because the patient’s overall functional status is declining; the patient has a gradual worsening of existing problem and/or a new but anticipated problem; and/or the carer(s)/family undergo(es) gradually worsening distress that impacts on the patient’s care.
Deteriorating Phase End: The patient condition plateaus (that is, the patient is now stable); or there is an urgent change in the care plan or emergency treatment; and/or the family/carer(s) have a sudden change in their situation that impacts on patient care, and urgent intervention is required (that is, the patient is now unstable); or death is likely within days (that is, the patient is now terminal).
Terminal Phase Start: Death is likely within days.
Terminal Phase End: The patient dies or the patient’s condition changes and death is no longer likely within days (that is, the patient is now stable or deteriorating).
The diagnosis established after study to be chiefly responsible for occasioning the patient's episode of admitted patient care.
In palliative care, symptoms or problems with scores in the moderate/severe range trigger interventions and actions by health practitioners to respond to moderate or severe needs. This is referred to as responsive care by PCOC.
Responsive care relates to care of patients that have moderate or severe symptoms/problems at the start of their phase of palliative care. To meet this benchmark, 60% of these phases must end with absent or mild symptom/problem scores.
The episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay (beginning or ending in a change of type of care; for example, from Acute care to Rehabilitation). Separation also means the process by which an admitted patient completes an episode of care by being discharged, dying, transferring to another hospital or changing type of care.
The PBS/RPBS do not cover medicines supplied to public hospital inpatients, over-the-counter medicines or private prescriptions.
A PBS/RPBS prescription is subsidised when the dispensed price of a medication exceeds the patient co-payment. The PBS and RPBS covers the difference between the full cost of the medication and the patient co-payment.
Specialist palliative care inpatient unit
Specified care and services
The care and services that all approved providers of permanent residential aged care must provide to any resident as needed, as set out by the Schedule of specified care and services for residential care services (Schedule 1, Quality of Care Principles 2014) within the Aged Care Act 1997.
The total hours worked per week in the profession.
Under co-payment prescription
A prescription priced below the co-payment as defined in the National Health Act 1953. A PBS/RPBS prescription is classified as under co-payment when the dispensed price of the prescription does not exceed the patient co-payment, and the patient pays the full cost of the medication.
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