SPARRA

1. SPARRA Peter Martin Programme Principal Long Term Conditions/Joint Future Programmes

2. 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

3. Historic Period 2002 2004 2003 2001 Outcomeyear Predictor variables 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 admission Total bed days accumulated in the 3 years Principal diagnosis (last emergency admission) Co-morbidity – number of diagnostic groups Number of Elective admissions Emergency Admission rate (standardised) of patient’s GP practice

4. Example: individual with very high 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

5. 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

6. 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

7. Match complexity of condition/care need with appropriate level of care/intervention

8. Development History 2006 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

9. 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

10. Digital story

11. 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 SMR01 history Evidence of Drug/Alcohol abuse

12. SPARRA coverage

13. Hospital Admissions A&E Prescribing Social Work Primary Care (General Practice) SPARRA – The Future Patient at Risk

14. www.isdscotland.org/ltc