Table 2

Validation of Australian medication-related potentially preventable hospitalisation clinical indicator set by expert panel

NumberHospitalisation outcomeProcess of care (preceding hospitalisation)AcceptedOverall score (%)Would you expect most health professionals to*
Recognise the problem in the process of care? (%)Foresee the potential for hospitalisation associated with the process of care? (%)Know how to change the process of care to reduce the likelihood of hospitalisation? (%)Be able to change the process of care to reduce the likelihood of hospitalisation? (%)
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)

Y71.574797463
2Acute coronary syndrome
  1. Patient has coronary artery stent (in 1 years prior to admission)

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

Y7578727278
3CHF
  1. History of CHF (in 2 years prior to admission)

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

Y72.580707070
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)

N6368636358
5CHF
  1. History of CHF

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

N3835294741
6CHF
  1. History of CHF

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

N54.556565056
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)

N3633284439
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)

Y7580857560
9CHF or MI1. Concurrent use of insulin and rosiglitazoneN48.553415347
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)

Y94.81001009584
11VTE or stroke
  1. History of coronary artery disease or VTE

  2. Use of raloxifene

N54.856506350
Mental health indicators
12Bipolar disorder
  1. History of bipolar disorder

  2. Use of lithium

  3. 3) Drug level not monitored in the previous 3 months

N6969637569
13Acute confusion
  1. Patient aged ≥65 years

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

N53.544446363
14Acute confusion
  1. Patient aged ≥65 years

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

N42.669505638
15Serotonin toxicity1. Use of duloxetine, fentanyl, tramadol, SSRIs, TCAs, or venlafaxine concurrently with MAOI or moclobemide, or within 14 days of stopping MAOIN5350505656
16Serotonin toxicity1. Concurrent treatment with strong CYP1A2 inhibitors (eg, duloxetine) with fluvoxamineN59.563566356
Respiratory indicators
17Asthma or COPD
  1. History of asthma or COPD

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

N51.250455060
18Asthma
  1. History of asthma

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

  3. No use of inhaled corticosteroids

Y92.5958510090
19COPD
  1. Moderate-to-severe COPD with frequent exacerbation

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

  3. No use of inhaled corticosteroids

Y90907510095
20Asthma or COPD
  1. History of asthma or COPD

  2. No contraindication to influenza vaccine

  3. No influenza vaccination in the previous year

Y82.580759085
21Influenza-related pneumonia
  1. Patient aged ≥65 years

  2. No contraindication to influenza vaccine

  3. No influenza vaccine in the previous year

Y87.585759595
22Pneumococcal pneumonia or sepsis
  1. Patient aged ≥65 years

  2. No contraindication to pneumococcal vaccine

  3. No pneumococcal vaccine in the previous 6 years

Y8080759075
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. 3) No use of gastroprotective agent (eg, PPI)

Y89.595849584
24Chronic constipation or impaction1. Use of 2 or more agents with low-to-moderate anticholinergic activity; OR use of a highly anticholinergic agentN34.342213737
25Chronic constipation or impaction
  1. Regular use of a strong opioid analgesic (fentanyl, oxycodone, morphine)

  2. No concurrent use of a laxative

Y9195799595
26GI ulcer
  1. Patient with dyspepsia

  2. PPI not prescribed

Y74.889588468
27GI ulcer
  1. Patient with a positive test for Helicobacter pylori

  2. Not prescribed H pylori eradication therapy (PPI twice daily, clarithromycin 500 mg twice daily and amoxycillin 1 g twice daily for 7 days; OR PPI twice daily, clarithromycin 500 mg twice daily and metronidazole 400 mg twice daily for 7 days; PPI twice daily, amoxycillin 500 mg three times a day and metronidazole 400 mg three times a day for 14 days)

Y86.889749589
28GI ulcer or bleed
  1. Patient with osteoarthritis

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

Y7184637958
29Oesophagitis, oesophageal ulceration or stricture
  1. History of oesophageal disorders (active oesophagitis, oesophageal ulceration, stricture or achalasia)

  2. Use of alendronate

N68.373686468
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)

Y80.891868264
31Fracture
  1. Female patient

  2. History of osteoporosis or fracture

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

Y81.895828664
32Fracture
  1. Male patient

  2. History of osteoporosis or fracture

  3. No use of bisphosphonate or teriparatide

Y72.882687764
33Fracture
  1. Patient aged ≥65 years

  2. History of osteoporosis

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

Y7691687768
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

N40.845324541
35Fracture
  1. Patient aged ≥65 years

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

Y71.582776859%
36Arrhythmia
  1. Concurrent use of calcitriol with digoxin

  2. Calcium concentration not monitored in the previous 3 months

N31.518184545
37Hypercalcaemia
  1. Use of calcitriol

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

N62.873556459
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

Y79.388658282
39Renal failure
  1. NSAID use for >3 months

  2. Serum creatinine not monitored in the previous 12 months

Y7976768876
40Renal failure
  1. Use of lithium

  2. Serum creatinine not monitored in the previous 3 months

N66.565656571
41Urinary retention
  1. History of BPH

  2. Use of an anticholinergic agent

N5959655953
42Urinary retention1. Use of 2 or more agents with anticholinergic activity OR use of a highly anticholinergic agentN39.535414141
Diabetes indicators
43Hyperglycaemia/hypoglycaemia
  1. Use of an oral hypoglycaemic agent

  2. HbA1c level not monitored in the previous 6 months

Y8595779573
44Hypoglycaemia
  1. Use of a long-acting oral hypoglycaemic agent (glibenclamide or glimepiride)

  2. HbA1c level not monitored in the previous 6 months

Y95100909595
45Hyperglycaemia or hypoglycaemia
  1. Use of insulin

  2. HbA1c level not monitored in the previous 6 months

Y91.5100959081
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

Y76.888757569
47Hypoglycaemia
  1. Use of glibenclamide or glimepiride

  2. Renal function not monitored in the previous year

Y81.575758888
48Cardiovascular disease
  1. History of diabetes

  2. Not on lipid lowering drug

Y81.888888863
  • Numbers in bold represent those who achieved an average score of ≥70% agreement by the expert panel.

  • *Percentage of respondents who answered ‘Agree’ or ‘Yes’ on the three-point Likert scale.

  • AF, atrial fibrillation; ARB, angiotensin receptor blocker; BPH, benign prostatic hyperplasia; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; GI, gastrointestinal; HbA1c, glycated haemoglobin; 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; SABA, short-acting β agonist; SSRI, selective serotonin reuptake inhibitor; TCA, transluminal coronary angioplasty; VTE, venous thromboembolism.