Long Term Conditions with United Health Europe

1. Long Term Conditions with United Health Europe JeanRobinson NottinghamHIS

2. Background • Several pilot projects across Nottingham • Rushcliffe LTC • B&H COPD • Gedling Action Team (GAT) • Various City projects – May Scheme, Intermediate Care etc • SHA keen for Nottingham to implement LTC

3. LDP • Emergency Admissions • Readmissions • Community Matrons

4. UHE • January / Feb 2005 presentations to Nottingham Health Community • June/July 2005 – signed up by TSHA • Nottingham City – lead PCT • Lead site for RISC and HealthNumerics

5. Demographics Ÿ Clinical Care Clinical Service Based Demographic Ÿ Pharmacy Risk Markers Risk Markers Markers Ÿ (Lab Results) Ÿ Age High Acuity Events Episode of Care Based Gender - Moderate/Lower Disease Prevalence Geography Risk Markers Co-morbidities - Rx Markers Complications - Lab Markers Weighting of Complete Patient Analysis Profile to Compute Patient Clinical Risk Profile Outputs Risk Risk Profiles Array Markers for Apply Weights Combine Profile and each Patient to Measuring Risk Results to Create a Clinical Risk Contribution of each Complete Patient Profile Marker to Overall Profile Risk RISC Model: to predict high risk patients

6. The process • Caldicott approval • Extract the data (Pop and Acute to start with) • Anonymise NHSNumber • Send the data to UHE • Data returned • Print reports for community matrons • HealthNumerics Installation and training

7. The data • Registered list • Inpatient activity – 3 years • Outpatient activity – 3 years • A&E activity – 3 years • Reference data

8. The data • MS Access files, one per PCT • Very specific file formats – as ClearNet • Reference files • GPPractice codes, Trust Codes, LSOAs and wards

9. Anonymise nhsnumber • Various methods discussed with UHE • Created Master patient index and new autoID number for each nhsnumber • Easy – but master index needs to be kept secure and up to date • Not scalable – if PCTs merge…

10. Data sent to UHE • UHE process the data • Attach a RISC score to each patient • RISC is designed to estimate for an individual person their future risk of health care service usage • RISC provides a report which outlines factors that drive therisk score

11. Data Returned - RISC • 4 databases (one per PCT) • Replace AutoID with NHS Number • Pre written reports • 1. List of patients in RISC order • 2. Individual patient profiles

12. Patient Lists

13. Patient Profile

14. Health Numerics • Analysis tool developed by UHE • Uses Population data (Registered list, Census data and activity data) • Provides aggregate reports • Standard reports • User reports – based on selecting criteria

15. Health Numerics • Allows analysis by • SOA, LSOA and ward • GP Practice • Other pre-specified geographies (localities etc) • IMD quintiles

16. 5 views • Population • Census variables • Age /sex breakdown • Commissioning • Inpatient, outpatient & A&E activity • PbR, tariff costs • Primary care services • Activity by practice - PbC • Care management – primary care data • Patient Choice – out of area activity

17. UHE experience • Very focussed on deadlines and getting things done • Supportive but demanding • Data preparation time consuming • Reports can be time consuming • No clear market for HN • Future costs could be considerable