Table 1

Australian medication-related potentially preventable hospitalisation clinical indicator set

NumberHospitalisation outcomeProcess of care (preceding hospitalisation)Level of evidenceSource of indicator
Previously published; not modifiedPreviously published; modified for this studyNewly developed
Cardiovascular indicators
1Acute coronary syndrome
  1. History of MI (in 2 years prior to admission)

  2. Not on aspirin, β-blocker, ACEI or ARB and statin (in 3 months prior to admission)

Aspirin, β-blocker—level I, ACEI/ARB, statin—level II28Changed outcome from just MI; added ACEI/ARB and statin6 7
2Acute coronary syndrome
  1. Patient has coronary artery stent (in 1 year prior to admission)

  2. No use of aspirin or clopidogrel (in 12 months prior to admission)

Level I2828
3CHF
  1. History of CHF (in 2 years prior to admission)

  2. Not on an ACEI or ARB (in 3 months prior to admission)

Level I26Added ARB for those intolerant to ACEI6–8
4CHF
  1. History of CHF (in 2 years prior to admission)

  2. Not on a heart failure indicated β-blocker (in 3 months prior to admission)

Level I2626
5CHF
  1. History of CHF

  2. Use of rosiglitazone or pioglitazone (in 6 months prior to admission)

Level I3333
6CHF
  1. History of CHF

  2. Use of NSAID (in 3 months prior to admission)

Level I49Removed fluid overload from outcome2 6–8
7CHF or cardiac ischaemic event
  1. History of IHD (in 2 years prior to admission)

  2. Use of rosiglitazone (in 6 months prior to admission)

Level I5033
8CHF and / or heart block
  1. History of CHF with heart block or advanced bradycardia (in 2 years prior to admission)

  2. Use of digoxin (in 6 months prior to admission)

Level III516–8
9CHF or MI1. Concurrent use of insulin and rosiglitazoneLevel III5033
10Ischaemic stroke
  1. History of chronic AF or ischaemic stroke in 2 years prior to admission)

  2. No use of warfarin or aspirin (in 3 months prior to admission)

Level I308
11VTE or stroke
  1. History of coronary artery disease or VTE

  2. Use of raloxifene

Level II5235
Mental health indicators
12Bipolar disorder
  1. History of bipolar disorder

  2. Use of lithium

  3. Drug level not monitored in the previous 3 months

Level I386 7
13Acute confusion
  1. Patient aged ≥65 years

  2. Use of two or more agents with anticholinergic activity OR use of an agent with high anticholinergic activity

Level III532
14Acute confusion
  1. Patient aged ≥65 years

  2. Use of multiple psychotropic medications (eg, benzodiazepines, tricyclic antidepressants)

Level III25 542
15Serotonin toxicityUse of duloxetine, fentanyl, tramadol, SSRIs, TCAs or venlafaxine concurrently with MAOI or moclobemide, or within 14 days of stopping MAOILevel III5425
16Serotonin toxicity Concurrent treatment with strong CYP1A2 inhibitors (eg, duloxetine) with fluvoxamineLevel III5425
Respiratory indicators
17Asthma or COPD
  1. History of asthma or COPD

  2. Use of a β-blocker eye drops for glaucoma

Level I558 13
18Asthma
  1. History of asthma

  2. Use of SABA more than 3 times/week or use of LABA

  3. No use of inhaled corticosteroids

Level I32Asthma only, Australian guideline specific7–9
19COPD
  1. Moderate to severe COPD with frequent exacerbation

  2. Use of long-acting β-agonist or anticholinergic

  3. No use of inhaled corticosteroids

Level I31COPD only, Australian guideline specific7–9
20Asthma or COPD
  1. History of asthma or COPD

  2. No contraindication to influenza vaccine

  3. No influenza vaccination in the previous year

Level I31 3231 32
21Influenza-related pneumonia
  1. Patient aged ≥65

  2. No contraindication to influenza vaccine

  3. No influenza vaccine in the previous year

Level I56 572
22Pneumococcal pneumonia or sepsis
  1. Patient aged ≥65

  2. No contraindication to pneumococcal vaccine

  3. No pneumococcal vaccine in the previous 6 years

Level III57 582
GI indicators
23GI bleed, perforation or ulcer or gastritis
  1. History of GI ulcer or bleeding

  2. NSAID use for at least 1 month

  3. No use of gastroprotective agent (eg, PPI)

Level II36 59Added gastroprotective agent6 7 13
24Chronic constipation or impaction1. Use of two or more agents with low-to-moderate anticholinergic activity; OR use of a highly anticholinergic agentLevel 1602
25Chronic constipation or impaction
  1. Regular use of a strong opioid analgesic (fentanyl, oxycodone, morphine)

  2. No concurrent use of a laxative

Level I618
26GI ulcer
  1. Patient with dyspepsia

  2. PPI not prescribed

Level I6225
27GI ulcer
  1. Patient with a positive test for Helicobacter pylori

  2. Not prescribed H pylori eradication therapy

Level I6325
28GI ulcer or bleed
  1. Patient with osteoarthritis

  2. Dispensed long-term NSAIDs (including COX-2) therapy

Level I6436
29Oesophagitis, oesophageal ulceration or stricture
  1. History of oesophageal disorders (active oesophagitis, oesophageal ulceration, stricture or achalasia)

  2. Use of alendronate

Level I6525
Osteoporosis/fracture indicators
30aOsteoporosis or fracture
  1. Use of systemic corticosteroids for at least 3 months

  2. No osteoporosis prophylaxis (women: no use of HRT, bisphosphonate, teriparatide, selective oestrogen receptor modulators or strontium; men: no use of bisphosphonate or teriparatide)

Level I66Removed dose8 13
30bOsteoporosis or fracture1. This indicator is the same as above, but for male patientsLevel I66Removed dose8 13
31Fracture
  1. Female patient

  2. History of osteoporosis or fracture

  3. No use of HRT, bisphosphonate, teriparatide, selective oestrogen receptor modulators or strontium

Level I35Changed from history
of fall6
32Fracture
  1. Male patient

  2. History of osteoporosis or fracture

  3. No use of bisphosphonate or teriparatide

Level II35Changed from history of fall2
33Fracture
  1. Patient aged ≥65 years

  2. History of osteoporosis

  3. Patient not receiving adequate levels of calcium and vitamin D

Level III352
34Fracture
  1. Patient on high dose inhaled corticosteroid (≥400 μg fluticasone daily or equivalent) for more than 1 year

  2. Bone mineral density not measured in the previous 24 months

Level II3525
35Fracture
  1. Patient aged ≥65 years

  2. Use of a falls-risk medicine (eg, long-acting hypnotic or anxiolytic, tricyclic antidepressant)

Level I67Included all falls-risk medicines6–8
36Arrhythmia
  1. Concurrent use of calcitriol with digoxin

  2. Calcium concentration not monitored in the previous 3 months

Level III6825
37Hypercalcaemia
  1. Use of calcitriol

  2. Plasma calcium concentration not monitored in the previous 3 months

Level III6925
Renal indicators
38Renal failure or nephropathy
  1. History of diabetes

  2. Microalbuminuria and plasma creatinine not monitored in the previous 12 months

  3. Patient not on ACEI or ARB

Level II—monitoring, Level I—ACE/ARB use7070
39Renal failure
  1. NSAID use for >3 months

  2. Serum creatinine not monitored in the previous 12 months

Level II36Changed monitoring from 3 to 12 months6 8
40Renal failure
  1. Use of lithium

  2. Serum creatinine not monitored in previous 6 months

Level III386 7
41Urinary retention
  1. History of BPH

  2. Use of an anticholinergic agent

Level III256 7
42Urinary retention1. Use of two or more agents with anticholinergic activity OR use of a highly anticholinergic agentLevel III25Combined to one indicator2
Diabetes indicators
43Hyperglycaemia/hypoglycaemia
  1. Use of an oral hypoglycaemic agent

  2. HbA1c level not monitored in the previous 6 months

Level I34Added hypoglycaemia
as outcome2 6
44Hypoglycaemia
  1. Use of a long-acting oral hypoglycaemic agent (glibenclamide or glimepiride)

  2. HbA1c level not monitored in the previous 6 months

Level I34Added HbA1c monitoring2
45Hyperglycaemia or hypoglycaemia
  1. Use of insulin

  2. HbA1c level not monitored in the previous 6 months

Level I3434
46Hyperglycaemia or hypoglycaemia
  1. Use of insulin or oral hypoglycaemic medicines

  2. Use of medicines that may increase or decrease blood glucose concentration

  3. HbA1c level not monitored in the previous 6 months

Level I3333
47Hypoglycaemia
  1. Use of glibenclamide or glimepiride

  2. Renal function not monitored in the previous year

Level II3333
48Cardiovascular disease
  1. History of diabetes

  2. Not on lipid lowering drug

Level II7171
  • ARB, angiotensin receptor blocker; BPH, benign prostatic hyperplasia; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; GI, gastrointestinal; HbA1c, glycated haemoglobin; HRT, hormone replacement therapy; IHD, ischemic heart disease; LABA, long-acting β agonist; MAOI, monoamine oxidase inhibitor; MI, myocardial infarction; NSAID, non-steroidal anti-inflammatory drug; PPI, proton pump inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, transluminal coronary angioplasty; VTE, venous thromboembolism.