SPARRA – Recent and Future Developments

Mark Sanderson

Health and Social Care Pathways ISD Scotland

SPARRA - Introduction

• SPARRA (Scottish Patients at Risk of Readmission and Admission) is a tool developed by ISD for predicting a patient’s risk of emergency inpatient admission to an acute hospital in the next year

• SPARRA is typically used to support local teams in providing pro-active, planned and co-ordinated care for patients with frequently changing or complex needs

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012

Classic All Ages

Hospitalisation Hospitalisation

The shift from a health care system geared towards reactive hospital-based treatment of acute conditions to one which is founded on a preventative, anticipatory approach …

Delivering for Health

Better Health, Better Care

LTC National Action Plan

20:20 Vision

Excel SPARRA Lists

Population Wide Prevention, Health Improvement & Health

Promotion

Interven

tions

Intensive case/care Management

Acute sector

Very High

Disease/care management

Self management

Targeted primary prevention Lower risk

Medium risk

High risk

Kaiser-Permanente Pyramid

SPARRA

- Classic

- All Ages

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012

Classic All Ages Version 3

Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric

Hospitalisation Hospitalisation

The shift from a health care system geared towards reactive hospital-based treatment of acute conditions to one which is founded on a preventative, anticipatory approach …

Delivering for Health

Better Health, Better Care

LTC National Action Plan

20:20 Vision

Excel SPARRA Lists

Datasets and Risk Factors

Outpatient(Oct 2008 to Sept 2009)

Emergency Department(Oct 2008 to Sept 2009)

Prescribing (Oct 2008 to Sept 2009)

Outcome Year(Oct 2009 to Sept 2010)

OUTCOME PERIOD

Hospitalisation(Oct 2006 to Sept 2009)

PRE-PREDICTION PERIOD

Psychiatric Admission(Oct 2006 to Sept 2009)

Any recent admissions to a psychiatric unit ?

Any A&E attendances in the past year?

What type of outpatient

appointments did the patient have?

Any prescriptions for e.g. dementia drugs? Or

substance dependence?

How many outpatient appointments?

What age is the patient?

How many previous emergency admissions

has the patient had?

How many prescriptions?

Any previous admissions for a long term condition

(such as epilepsy?

Coverage of Version 3

Population of Scotland = 5,194,000 Population covered by SPARRA Version 3 = 3,500,000

Number of Emergency Admissions in a Year = 342,500

Population covered by SPARRA “All Ages” = 687,000

Overlap between emergency admission patients and SPARRA “All Ages” = 40%

Overlap between emergency admission patients and SPARRA Version 3 = 95%

New and Current Risk Scores

Note: 2.67m patients have a SPARRA Version 3 risk score of less than 10%. The equivalent figure is 217,000 for the current tool.

SPARRA - New and Current Risk Scores

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100%

Risk Score

Num

ber o

f Pat

ient

s

Version 3All Ages

Three Sub-Cohorts

New cohorts …..

• Long Term Conditions

– aged 16-74

• Frail Elderly

– aged 75+

• Younger Emergency Department

– aged 16-55

– At least one ED attendance in previous 12 months

…. new opportunities …

Version 3 Model Factors

Frail Elderly

All cohorts

Younger ED

LTC

Age

Prescriptions in specific BNF chapters

Deprivation

Alcohol/ substance misuse related admissions

Prescriptions for specific groups of drugs

Psychiatric admissions Deprivation

New OP attendances Polypharmacy

ED attendances

Emergency bed days

LTC related admissions

Emergency / elective / daycase admissions

Prescriptions/admissions indicating particular conditions

New OP attendances for MH

Local SPARRA Model – NHS Ayrshire and Arran

• Development of a local SPARRA model using data sources not available at national level to support the NHS Board’s community ward pilot and to inform longer term national development of SPARRA

• Data sources

– practice

– out of hours

– emergency department

– referrals

– hospitalisation

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012

Classic All Ages Version 3

Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric

Hospitalisation Hospitalisation

The shift from a health care system geared towards reactive hospital-based treatment of acute conditions to one which is founded on a preventative, anticipatory approach …

Delivering for Health

Better Health, Better Care

LTC National Action Plan

20:20 Vision

Excel SPARRA Lists

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012

Classic All Ages Version 3

Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric

Hospitalisation Hospitalisation

The shift from a health care system geared towards reactive hospital-based treatment of acute conditions to one which is founded on a preventative, anticipatory approach …

Delivering for Health

Better Health, Better Care

LTC National Action Plan

20:20 Vision

Excel

SPARRA Online SPARRA Lists

SPARRA Online

• SPARRA online offers secure user-friendly access to SPARRA data through a Business Objects universe

• It provides patient listings and risk score history

• It can be used to generate own queries or use the pre-generated reports

• The security settings allow access to GP, Community Health Partnership (CHP) and/or NHS Board level access to users

SPARRA – The Future Under 16 model

Automation

Version 3

SPARRA – The Future Under 16 model

Automation

Polypharmacy

CMS (Chronic Medication Service) Version

3

SPARRA – The Future Under 16 model

Automation

Polypharmacy

CMS (Chronic Medication Service) Version

3

QOF QP12-14

SPARRA – The Future

iSPARRA

Under 16 model

Automation

Polypharmacy

CMS (Chronic Medication Service) Version

3

QOF QP12-14

iSPARRA

• Incorporate SPARRA into a Management Information System

• Wider benefits of risk stratification

• User-friendly front-end, dashboard and drill-down

• Access to the full Version 3 dataset

SPARRA – The Future

iSPARRA

Under 16 model

Automation

Polypharmacy

CMS (Chronic Medication Service) Version

3

QOF QP12-14

SPARRA – The Future

iSPARRA

Under 16 model

Automation

Polypharmacy

CMS (Chronic Medication Service)

NHS24

Ambulance Service …

… Out of Hours?

Version 3

QOF QP12-14

SPARRA – The Future

iSPARRA

Other outcomes

• Early readmission

• ED attendance

• Admission to care home

Under 16 model

Automation

Polypharmacy

CMS (Chronic Medication Service)

NHS24

Ambulance Service …

… Out of Hours?

Version 3

QOF QP12-14