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 T...
SPARRA  Scottish  Patients  At  Risk of  Readmission and  AdmissionSPARRA is an algorithm for predicting a patient’s risko...
SPARRA – Current Risk factors  Age  Gender  Deprivation Level of Residence  Number of previous emergency admissions  Time ...
Example: individual with very highpredicted probability of admission• Predicted probability of admission   86%• Male aged ...
Example: individual with very lowprobability of admission• Probability of admission   8%• Male aged 67• 2 years since most...
Development History2006•   Initial Focus on those aged 65+•   Base-data     – Sources from National Inpatient/Day Case Dat...
SPARRA the ISD service• Risk Scores generated quarterly for all relevant patients   – >700K (previously 200K)• Data relati...
SPARRA – current coverage                     Very                   Acute                                     ency       ...
SPARRA – Current Development Strategy• Priority is more comprehensive case-finding tool   “Enhance SPARRA by expanding the...
SPARRA – Current Projects• Using external data sources e.g.    – Data held by Primary Care Clinical Informatics Unit, Aber...
Long Term Conditions Collaborative‘Delivering sustainable improvements in person centred services for people with         ...
Policy Context• Long Term Conditions Action Plan – June 2009  – Person Centred Care & Mutuality  – 7 Change Actions• Linke...
LTC Collaborative Workstreams                           Level 3              Complex      Highly              Case/Care   ...
Complex Care Workstream          Risk Prediction             (SPARRA)                                • Learning   Events  ...
Current Developments & PracticeSPARRA                                Tests of Change                                      ...
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Peter Martin & Mandy Andrew: SPARRA

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Peter Martin & Mandy Andrew: SPARRA

  1. 1. SPARRA Peter Martin (ISD) Mandy Andrew(Long Term Conditions Collaborative)
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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)
  9. 9. SPARRA – current coverage Very Acute ency merg ns sector High E SPARRA issio adm High risk coverage Medium risk Lower risk 4
  10. 10. 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)
  11. 11. 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
  12. 12. Long Term Conditions Collaborative‘Delivering sustainable improvements in person centred services for people with long term conditions’ Improvement and Support Team Scottish Government
  13. 13. 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
  14. 14. 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
  15. 15. Complex Care Workstream Risk Prediction (SPARRA) • Learning Events • Buddying • Resources • Whole Systems ImprovementAnticipatory CareCare Plans Management
  16. 16. 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)

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