The past ….

SPARRA – Past, Present and Future

Mark Sanderson

Health and Social Care Information ProgrammeISD Scotland

The past ….

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

ExcelSPARRA Lists

Population Wide Prevention, Health Improvement & Health

Promotion

Inte

rventio

ns

Intensive Case/care Management

Emergency

admissions

Acutesector

Very High

Disease/caremanagement

Selfmanagement

Targeted Primary Prevention Lower risk

Medium risk

High risk

Kaiser-Permanente Pyramid

SPARRA

- Classic

- All Ages

…. the present ….

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012

Classic All Ages Version 3

Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric






20:20 Vision

ExcelSPARRA 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 = 5,194,000Population 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

Nu

mb

er o

f P

atie

nts

Version 3

All 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 attendancesPolypharmacy

ED attendances

Emergency bed days

LTC related admissions

Emergency / elective / daycase admissions

Prescriptions/admissions indicating particular conditions

New OP attendances for MH

Local Collaborations

• Development of local algorithms/tools

• Support local initiatives e.g. virtual ward model

• Informs longer term national development of SPARRA

– Use of data sources not available at national level

• Two active projects

– NHS Ayrshire & Arran

– West Lothian CHCP

Use of SPARRA

• Wide variation in take-up and use

• Primarily used for case-finding

• Limited strategic application

• Knowledge café

– NHS Ayrshire and Arran

– Aberdeenshire CHP

– East and Midlothian Anticipatory Care Service

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012








20:20 Vision

ExcelSPARRA Lists

SPARRA Timeline

2005 2006 2007 2008 2009 2010 2011 2012








20:20 Vision

Excel

SPARRA OnlineSPARRA 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, CHP and/or NHS Board level access to users

• Roll-out at an advanced stage

…. and the future

SPARRA – The Future

Version

iSPARRA

Tool

s and

acc

essib

ility

3

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


Version

iSPARRA

Tool

s and

acc

essib

ility

3


Version

iSPARRA

Tool

s and

acc

essib

ility

Data sourcesNHS24

SAS …

… Out of Hours?

3


Version

iSPARRA

Tool

s and

acc

essib

ility

SPARRA Version

3

Under 16 model

Automation

Data sourcesNHS24

SAS …

… Out of Hours?

3


Version

iSPARRA

Tool

s and

acc

essib

ility

SPARRA Version

3

Under 16 model

Automation

Data sourcesNHS24

SAS …

… Out of Hours?B

enefits

Evaluation

3


Version

iSPARRA

Tool

s and

acc

essib

ility

Pres

crib

ing

data

SPARRA Version

3

Under 16 model

Automation

Polypharmacy

Data sourcesNHS24

SAS …

… Out of Hours?B

enefits

Evaluation

3


Version

iSPARRA

Tool

s and

acc

essib

ility

Pres

crib

ing

data

Other outcomes

• Early readmission

• ED attendance

• Admission to care home

Risk prediction

SPARRA Version

3

Under 16 model

Automation

Polypharmacy

Data sourcesNHS24

SAS …

… Out of Hours?B

enefits

Evaluation

3


Version

iSPARRA

Tool

s and

acc

essib

ility

Pres

crib

ing

data

Other outcomes

• Early readmission

• ED attendance

• Admission to care home

Risk prediction

SPARRA Version

3

Under 16 model

Automation

What Else?

Polypharmacy

Data sourcesNHS24

SAS …

… Out of Hours?B

enefits

Evaluation

3

Website: www.isdscotland.org/sparra

E-mail: [email protected]

Further Information

The past ….

Documents

Transcript of The past ….