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An overview of Parr in    practice in Northern          Ireland.           Marina Lupari     Head of nursing- research &de...
Key Statistics for Northern Ireland 1.8 people living in N. Ireland 160k emergency admissions to hospital each  year. O...
About the NHSCT The Northern Health and Social Care Trust provides    a broad range of health and social care services. ...
Drivers for Change - 2004 The Health Economy had recognized a need for    tighter financial efficiency and cost effectiv...
Care pathways links between primary, secondary and community care services in                               chronic diseas...
Care pathways links between primary, secondary and community care services in                               chronic diseas...
Overview of the PARR Tool and        Data Preparation Process                             Patient admitted/discharged     ...
Initial review of CICM service                                                          Within 1                          ...
Admissions to UHT by Diagnostic Group                       - for those Admissions in both Year BEFORE & AFTER Referral to...
Drivers for Change - 2007   Proposal to Centralise the PARR Analysis to allow for the    identification of admissions/act...
Summarisation of key components of      study design & methodologyApril 06…         June 2008- November 2009 approx       ...
Research Objectives and link toPARR Aim- to establish if the introduction of a case management  approach for chronic cond...
“PARR” identified referrals to CICM                      Result of Assessment   No.     %    CCN caseload                 ...
Distribution Chart showing PARR Scores across Research Groups      Count of ID250               216         199200150100  ...
Distribution Chart of Major Chronic Conditions by Research Group350           295   295300250200                          ...
0                                                                                     10                                  ...
PARRChronic Conditions                      Research Group       20-29   30-39   40-49   50-59          60-69   70-79   80...
Distribution Chart : Showing "relevant" rehospitalisations      Sum of SumOfAdmissions100                        899080   ...
Distribution chart: Beddays by Relevant Conditions across Research                                                Groups  ...
Distribution Chart: Relevant Adms by PARR Score160         150140   1321201008060                    48                   ...
What have we learnt so far ? We know PARR can predict people at risk of  all rehospitalisations for about 75 % of people...
So where to now? Continue with data analysis Investigate the relationship of PARR and  avoidable re hospitalisations mor...
Marina Lupari: An overview of PARR in practice in Northern Ireland
Marina Lupari: An overview of PARR in practice in Northern Ireland
Marina Lupari: An overview of PARR in practice in Northern Ireland
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Marina Lupari: An overview of PARR in practice in Northern Ireland

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Transcript of "Marina Lupari: An overview of PARR in practice in Northern Ireland"

  1. 1. An overview of Parr in practice in Northern Ireland. Marina Lupari Head of nursing- research &development, NHSCT/PhD student, UU
  2. 2. Key Statistics for Northern Ireland 1.8 people living in N. Ireland 160k emergency admissions to hospital each year. Over 700k attendances at A&E Depts. Our Ambulance service provides over 350k journeys, of which 88k are emergencies. 5 integrated Health & Social Care Trusts.
  3. 3. About the NHSCT The Northern Health and Social Care Trust provides a broad range of health and social care services. The Northern Health and Social Care Trust became operational on 1 April 2007, combing 3 legacy trusts. It is geographically the largest trust in Northern Ireland and operates from approximately 150 locations, serving a population of 443k people. The Trust employs approximately 14,000 staff. We have an annual budget of £550 million. We provide a range of services from nine hospitals and a large number of community based settings including peoples own homes.
  4. 4. Drivers for Change - 2004 The Health Economy had recognized a need for tighter financial efficiency and cost effectiveness in service delivery.  better approaches to the management of chronic disease. These multiple challenges included:  the under-coordination of health services, limited incentives and training for health care professionals.  poor diagnostic methods, limited disease management protocols, lack of patient involvement in managing disease.  stove-piped funding mechanisms. These realities underpinned:  recent efforts to change existing structures and practices in order to increase service efficiency in chronic disease management  and improve health outcomes for people living with chronic illness.
  5. 5. Care pathways links between primary, secondary and community care services in chronic disease management Primary Care Secondary CarePatient with suspected Chronic Patients with known Chronic condition – disease exacerbation of condition Hospitalisation Appropriate investigations to confirm diagnosis Community Based Specialist Nurse PARR AssessmentGP referral onwards for support Continuing Care Nurse Case Finder (CCN) visits pt at home Case Management Co-ordinator Patient assessment, review, treatment, education, referral to other professionals services & support programmes including domiciliary servicesPrimary Community rehab Chronic Conditions ACAHT- Multi Patient Asst. Care inc cardiac/ Management acute skills support TechnologyNursing pulmonary rehab programme needs network Group Team
  6. 6. Care pathways links between primary, secondary and community care services in chronic disease management Primary Care Secondary CarePatient with suspected Chronic Patients with known Chronic condition – disease exacerbation of condition Hospitalisation Appropriate investigations to confirm diagnosis Community Based Specialist Nurse PARR AssessmentGP referral onwards for support Continuing Care Nurse Case Finder (CCN) visits pt at home Case Management Co-ordinator Patient assessment, review, treatment, education, referral to other professionals services & support programmes including domiciliary servicesPrimary Community rehab Chronic Conditions ACAHT- Multi Patient Asst. Care inc cardiac/ Management acute skills support TechnologyNursing pulmonary rehab programme needs network Group Team
  7. 7. Overview of the PARR Tool and Data Preparation Process Patient admitted/discharged Activity recorded on Trust PAS PARR DATABASE Activity downloaded into PARR Via Business Objects, Trust Designed MS Access Database Sifting & criteria Risk Level Identified applied OTHER PATIENTDATA APPLIED CASE FINDING DATABASE CCN Nurse assesses, accepts THE ‘CASELOAD MANAGEMENT’ PROCESS
  8. 8. Initial review of CICM service Within 1 year PRIOR 1-2 years to Within 1 year PRIOR to Referra AFTER Referral l to Referral to CCN CCN to CCNActivity Type service service serviceAdmissions 110 215 143Spell Beddays 1466 2307 1903Avg LoSpell 13.3 10.7 13.3% of Individuals who had Adms in year (%/167) 35.3% 68.9% 38.3%Avg No. of Relevant Adms per individual (n=167) 0.7 1.3 0.9Actual No. of Individuals who had relevant Adms in the year 59 115 64
  9. 9. Admissions to UHT by Diagnostic Group - for those Admissions in both Year BEFORE & AFTER Referral to CCN Count of Date of Admission Only35302520 Post CCN Service1510 5 0 Jul Jul Jul Aug Aug Apr Apr Sep Feb Sep Feb Jun Jan Jun Jun Jan Jun Dec Dec May May May May Nov Nov Mar Mar Oct Oct 2005 2006 2006 2007 2. within 1 year PRIOR to Referral to CCN service 3. within 1 year AFTER Referral to CCN service Condition Diabetes Heart Other Resp Time Banding Years Date of Admission Only
  10. 10. Drivers for Change - 2007 Proposal to Centralise the PARR Analysis to allow for the identification of admissions/activity across different providers to be integrated. Trusts moving to “Real Time” recording of Clinical Diagnoses and thereby aiding the identification of prospective “Caseload Management” patients in real time. Regional Unique Identifier now available i.e. HCN to track individuals across services. Need to tie in other data sources, i.e. Primary Care activity such as Attendances at surgery, Out of Hours service usage, Medications etc. to improve complexity of PARR Tool (subject to evidence/research). Organise for N.I. Deprivation Measures to be added to PARR Tool. Need to understand full capability of PARR and it’s application to service provision.
  11. 11. Summarisation of key components of study design & methodologyApril 06… June 2008- November 2009 approx Intervention Group Comparison Group Locality A (n=295) Locality B (n=295) Case Usual Care Management CM Care Introduced Data Gathering Data Gathering Patient specific Locality A Patient specific FIM FIM HR-QOL HR-QOL Economic Proforma Economic Proforma Carers Strain Index Carers Strain Index - Carers Focus group - Carers Focus group
  12. 12. Research Objectives and link toPARR Aim- to establish if the introduction of a case management approach for chronic conditions is effective and/ or cost effective Does PARR predict patients accurately at risk of rehospitalisation and how can we move towards prediction of avoidable rehospitalisations? What is the relationship between PARR, reduction in rehospitalisations and the intervention? Is there any relationship between PARR and the specific chronic condition, and/or presence of co-morbidities ?
  13. 13. “PARR” identified referrals to CICM Result of Assessment No. % CCN caseload 1122 33.5% CCN Discharge 319 9.5% Mortality 670 20.0% Renal Failure 27 0.8% Inappropriate referral CCN 826 24.7% Other handover 103 3.1% Palliative care 82 2.4% PCNT handover 46 1.4% Service declined 154 4.6% 3349Position @ Jun09
  14. 14. Distribution Chart showing PARR Scores across Research Groups Count of ID250 216 199200150100 56 44 50 23 14 10 9 5 4 1 4 1 2 2 0 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 Research Group Control Group Intervention Group PARR
  15. 15. Distribution Chart of Major Chronic Conditions by Research Group350 295 295300250200 193 186 158 145150 113 113100 61 46 50 0 No. in Research Group Asthma COPD Diabetes Heart Failure Control Group Intervention Group
  16. 16. 0 10 20 30 40 50 60 70 80 Asthma Asthma / Diabetes Count of ID Asthma / Diabetes /Heart Failure Asthma/ COPD Asthma/ COPD/ Diabetes Asthma/ COPD/ Diabetes/ Heart Failure Asthma/ COPD/ Heart Failure Control Group Research Group Asthma/ Heart FailureChronic Conditions COPD Drop Page Fields Here Intervention Group COPD/ Diabetes COPD/ Diabetes/ Heart Failure COPD/ Heart Failure Diabetes Distribution Chart showing the Multiple Co-Morbidities for Research Groups Diabetes/ Heart Failure Heart Failure
  17. 17. PARRChronic Conditions Research Group 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 TotalAsthma Control Group 4 2 2 1 9 Intervention Group 7 2 9Asthma / Diabetes Control Group 6 1 1 8 Intervention Group 15 2 17Asthma / Diabetes /Heart Failure Control Group 3 1 4 Intervention Group 1 2 3Asthma/ COPD Control Group 1 1 1 3 Intervention Group 2 1 1 4Asthma/ COPD/ Diabetes Control Group 2 1 1 4 Intervention Group 4 4 8Asthma/ COPD/ Diabetes/ Heart Failure Intervention Group 2 2Asthma/ COPD/ Heart Failure Control Group 2 2 Intervention Group 4 1 5Asthma/ Heart Failure Control Group 10 4 2 16 Intervention Group 12 1 13COPD Control Group 29 14 3 4 1 51 Intervention Group 47 3 1 2 2 1 1 57COPD/ Diabetes Control Group 14 4 1 19 Intervention Group 21 4 1 2 28COPD/ Diabetes/ Heart Failure Control Group 12 5 3 1 1 22 Intervention Group 14 2 1 1 18COPD/ Heart Failure Control Group 34 6 3 1 44 Intervention Group 50 10 6 2 1 1 1 71Diabetes Control Group 9 1 3 1 1 15 Intervention Group 7 5 1 1 14Diabetes/ Heart Failure Control Group 34 5 1 1 41 Intervention Group 15 5 2 1 23Heart Failure Control Group 39 13 2 2 1 57 Intervention Group 15 3 3 2 23Grand Total 415 100 37 19 9 5 3 2 590
  18. 18. Distribution Chart : Showing "relevant" rehospitalisations Sum of SumOfAdmissions100 899080 7670 63 6360 51 52 4750 4240302010 0 T0 T3 T6 T9 Yes Research Group Control Group Intervention Group Included in Study T Band
  19. 19. Distribution chart: Beddays by Relevant Conditions across Research Groups Sum of SumOfLength of Spell1800 678 699 673700 632 649600 560500 384 367400300200100 0 T0 T3 T6 T9 Yes Research Group Control Group Intervention Group Included in Study T Band
  20. 20. Distribution Chart: Relevant Adms by PARR Score160 150140 1321201008060 48 3740 18 20 20 16 1520 11 8 7 1 0 20-29 30-39 40-49 50-59 60-69 70-79 80-89 Yes Control Group Intervention Group
  21. 21. What have we learnt so far ? We know PARR can predict people at risk of all rehospitalisations for about 75 % of people We know PARR and our intervention can save rehospitalisations / beddays We know we need to look at how better to predict those people at risk of avoidable rehospitalisations We need to look at the impact of social deprivation for NI
  22. 22. So where to now? Continue with data analysis Investigate the relationship of PARR and avoidable re hospitalisations more fully DHSSPS have agreed to run PARR across NI Look at what everyone else is doing and see how we can improve
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