SPARRA Peter Martin Programme Principal Long Term Conditions/Joint Future Programmes.
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Transcript of SPARRA Peter Martin Programme Principal Long Term Conditions/Joint Future Programmes.
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SPARRAPeter Martin
Programme PrincipalLong Term Conditions/Joint Future
Programmes
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What is SPARRA?
ScottishPatientsAtRisk ofReadmission andAdmission
SPARRA is an algorithm for predicting a patient’s risk of emergency inpatient admission to an acute hospital in a particular year
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A bit more detail
• To estimate a patient’s risk the algorithm uses the patient’s demographics (age, sex, deprivation) and factors from their history of hospital admission over the 3 years prior to the year of interest
Number of previous emergency admissions
Time since last emergency admissionTotal bed days accumulated in the 3 yearsPrincipal diagnosis (last emergency admission)Co-morbidity – number of diagnostic groupsNumber of Elective admissionsEmergency Admission rate (standardised) of patient’s GP practice
Predictor variables
Outco
me
year
Historic Period2001 2002 2003 2004
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Example: individual with very very highhigh predicted 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
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Example: individual with very low probability 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
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2006
• Pressures on Acute system– Rates of emergency admission rising steadily.– Small % pop accounting for large % bed days– Mainly older people experiencing multiple admissions– Projections - population is getting/will get older
• Kerr Report / Delivering for Health
– Shift from ‘crisis-driven’ hospital-based treatment of acute conditions to a system of that uses a preventative /anticipatory approach to the management of patients with long-term conditions
– System that is person-based and less disease-based and takes into account all their health & social care needs and assigns & applies the appropriate level of care/interventions in an integrated & coordinated way.
• Need for risk-stratification tools– To sssess the level of risk/stratify/case-find– Used extensively in USA / English PARR model
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4
Population Wide Prevention, Health Improvement & Health Promotion
Interventions
Intensive Case/care Management
Population health managementLong-term conditions
Emergency
admissions
Acutesector
Very High
Disease/caremanagement
Selfmanagement
Targeted Primary Prevention Lower risk
Medium risk
High risk
Match complexity of condition/care
need with appropriate level
of care/intervention
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Development History2006
Focus on those aged 65+
• Base-data
– Source from linked SMR01 / Deaths
– Patients with >=1 emergency adm 2001-2003 (200K+)
– Risk of admission 2004 – outcome was known
– Deaths before end of 2003 excluded
• Algorithm developed using multiple logistic regression
2008
Extension to those under 65
• Modelling work repeated on an ‘all ages’ cohort (700K+)
• Identifies 2 x high risk (50%) patients (28% more 65+)
• Adopted within the SPARRA service January 2009
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SPARRA & Case Management
• SPARRA identifies ‘high risk ‘ patients with complex care needs
– they often benefit from additional case management/ co-ordination
• A number of models in place/being tested
– Further assessment/reviews/referral
– Anticipatory Care/Self- Management Plans
– Sharing of information eg A&E, Out of Hours
– Diseases-specific (eg COPD) interventions
– Dedicated case managers
– GP-lead Local Enhanced Services
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Digital story
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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 informationRisks scores & factor valuesLTCs evident from SMR01 historyEvidence of Drug/Alcohol abuse
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4
Population health managementLong-term conditions
Emergency
admissions
Acutesector
Very High
Lower risk
Medium risk
High risk
SPARRA
coverage
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SPARRA – The Future
Primary Care (General Practice)
Hospital Admissio
ns
A&E Prescribing
Social Work
Patient at Risk
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www.isdscotland.org/ltc