Peter Martin & Mandy Andrew: SPARRA
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Peter Martin & Mandy Andrew: SPARRA

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Peter Martin & Mandy Andrew: SPARRA Peter Martin & Mandy Andrew: SPARRA Presentation Transcript

  • SPARRA Peter Martin (ISD) Mandy Andrew(Long Term Conditions Collaborative)
  • SPARRA• What does it do? – Risk factors / Patient Examples• History of Development• How is it being used? – The Long Term Conditions Collaborative• Current & Future Development
  • SPARRA Scottish Patients At Risk of Readmission and AdmissionSPARRA is an algorithm for predicting a patient’s riskof emergency inpatient admission in a particular year
  • SPARRA – Current Risk factors Age Gender Deprivation Level of Residence Number of previous emergency admissions Time since last emergency admission Inpatient/Day Case history in 3 Total bed days accumulated in the 3 years years prior to the Principal diagnosis (last emergency admission) risk year Co-morbidity – number of diagnostic groups Number of Elective admissions Emergency Admission rate (standardised) of patient’s GP practice Historic Period 2007 2008 2009 2010 Predictor Outcome variables year
  • Example: individual with very highpredicted probability of admission• Predicted probability of admission 86%• Male aged 67• Less than one month since most recent admission• 6 previous emergency admissions• Glasgow – most deprived decile• Most recent admission diagnosis: COPD
  • Example: individual with very lowprobability of admission• Probability of admission 8%• Male aged 67• 2 years since most recent admission• 1 previous emergency admissions• Lothian – 2nd least deprived decile• Most recent admission diagnosis: Injury
  • Development History2006• Initial Focus on those aged 65+• Base-data – Sources from National Inpatient/Day Case Data (SMR01) – Patients with >=1 emergency admission 2001-2003 (200K+) – Risk of admission 2004 – outcome was known – Deaths before end of 2003 excluded• Algorithm developed using multiple logistic regression2008Extension to those under 65• Modelling work repeated on an ‘all ages’ cohort (700K+)• Identifies 2 x high risk (50%) patients• Adopted within the SPARRA service January 2009SPARRA MH – risk of psychiatric inpatient admission
  • SPARRA the ISD service• Risk Scores generated quarterly for all relevant patients – >700K (previously 200K)• Data relating to their ‘at risk’ population distributed to Health Boards, CHPs & practices – Chosen risk thresholds (often >50%) – Patient-level data for medium to high risk patients ID information Risks scores & factor values LTCs evident from inpatient/day case history Admissions related to substance misuse (alcohol/drugs)
  • SPARRA – current coverage Very Acute ency merg ns sector High E SPARRA issio adm High risk coverage Medium risk Lower risk 4
  • SPARRA – Current Development Strategy• Priority is more comprehensive case-finding tool “Enhance SPARRA by expanding the cohort for whom a risk can be estimated beyond those with a recent history of hospital admission” Scottish Government – National LTC Action Plan• Need to look at other data sources that –will extend the cohort –contain risk factors that will improve discriminatory power – are likely to be available in most localities A& E Hospit al Communit y NHS24 Social Care Prescribing Admissions Syst ems Ambulance Primary Care (General Pract ice)
  • SPARRA – Current Projects• Using external data sources e.g. – Data held by Primary Care Clinical Informatics Unit, Aberdeen University on 40 practices and linked with national hospital admission data• Maximising/simplifying use of hospital admission data – Admissions related to alcohol or drug misuse – Admissions related to falls – LTCs• Streamlining our data generation/distribution process – Making using of ISD’s warehousing developments – Monthly updates• SPARRA MH – Evaluating long-term role – Overlaps with ‘acute’ SPARRA cohort
  • Long Term Conditions Collaborative‘Delivering sustainable improvements in person centred services for people with long term conditions’ Improvement and Support Team Scottish Government
  • Policy Context• Long Term Conditions Action Plan – June 2009 – Person Centred Care & Mutuality – 7 Change Actions• Linked to Long Term Conditions Collaborative High Impact Changes• Integrating Policy Streams
  • LTC Collaborative Workstreams Level 3 Complex Highly Case/Care complex Management Specialist Level 2 (Condition) Management High risk Level 1 Self Management 70-80% of pop
  • Complex Care Workstream Risk Prediction (SPARRA) • Learning Events • Buddying • Resources • Whole Systems ImprovementAnticipatory CareCare Plans Management
  • Current Developments & PracticeSPARRA Tests of Change • East• Using external data sources – Workforce (NHS Forth Valley)• Maximising/simplifying use of • West hospital admission data – Care Management Model• Streamlining our data (NHS Lanarkshire) generation/distribution process • North – A3s and Anticipatory Care• SPARRA Mental Health Planning (NHS Grampian)• SPARRA development group – Integrated Care Model (NHS Tayside)