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Health Forecasting Home Energy Conference May 11 2005 Dr William Bird

Health Forecasting Home Energy Conference May 11 2005 Dr William Bird Clinical Director, Health Forecasting. THE EFFECT OF COLD ON HEALTH. The Effect of Cold on Hospital Admissions. 1.4. 1.2. 1.0. 0.8. 0.6. 0.4. 0.2. 0. London. North Italy. Netherlands. North Finland.

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Health Forecasting Home Energy Conference May 11 2005 Dr William Bird

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  1. Health Forecasting Home Energy Conference May 11 2005 Dr William Bird Clinical Director, Health Forecasting

  2. THE EFFECT OF COLD ON HEALTH

  3. The Effect of Cold on Hospital Admissions

  4. 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0 London North Italy Netherlands North Finland South Finland Baden-Wurttemberg PublicExtra winter mortality% increase in mortality for each 1ºC fall from 18ºC Keatinge et al, 1997

  5. Public Prevention Regression coefficients for cold-related mortality from respiratory disease standardised at 70C. *p<0.05 **p<0.01 Avoid Shivering +24** Stationary (>2 mins) +13* Encourage -5* -3 -7** Warm Housing Anorak Hat

  6. Respiratory Effects of Cold • Cold causes bronchoconstriction • Cold inhaled air on the lower airways • Facial cooling • In COPD patients cold bedroom temperatures are related to the development of a ‘cold’ and an exacerbation. This may be related to cooling of nasal passages. • Increase in exacerbations related to cold outdoor temperatures. • Following a fall in temperature there is a lag for respiratory deaths peaking at 12 days.

  7. Keeping the house warm • There is good evidence that cold houses cause increased mortality across all social classes. Indoor temperatures are related to respiratory deaths. • A study in London demonstrated that cold bedroom temperatures are related to increased “common colds” in patients with COPD. • There is no evidence in the misconceptions that cold houses or that sleeping with the bedroom window open is “healthy” despite 40% of elderly doing so.

  8. HEALTH FORECASTING FOR COPD

  9. The Effect of Cold on Different Groups • PATIENT PATHWAY • IDENTIFY PATIENTS • STRATIFY PATIENTS • BASELINE TREATMENT • FORECAST • INTERVENTION Elderly, Old Houses, Post Code PUBLIC COPD COPD, CHD, Chronic Disease, PATIENT Health Centre, Out of Hours, Social Services PRIMARY CARE Managers, A&E, Clinicians HOSPITALS

  10. Met Office Winter 04/05 Trial • COPD forecast for PCTs and hospitals to allow anticipatory care. • COPD advisory Group chaired by David Halpin (recent chair of NICE guideline committee). • Workload Forecast for Hospitals based on • Historic data • Real time admission data • Environmental factors • Evaluation by London School Hygiene Tropical Medicine funded by DH.

  11. COPD project SHA pilot project agreed. 8 Met Office service DevelopersAdmissions & COPD Prevention. DoH funded evaluation

  12. SERVICE DEVELOPERS Facilitate Actions Feedback of current situation Feedback of service

  13. COPD Burden • A PCT serving a population of 250,000 will have about 14,200 GP consultations every year for people with COPD. • 680 patients will be admitted to hospital, accounting for 9800 bed days. • Admission costs about £1700 • GP Consultation costs £56

  14. Results so far • One PCT has noted an 85% reduction in COPD admissions. • This could “save” the PCT £1.36 million a year • The forecasts are acting as a catalyst for integrated care between the patient social care, primary care, secondary care and the local authority. • The forecasts are 75% accurate.

  15. COPD AdmissionsPlymouth hospitals

  16. Cross-correlations / lags of COPD with weather Weekly “Coldness” measurevs COPD admissions Positive correlation: Cold snaps lead to increased COPD admissions, peaking 1-2 weeks later N.B. “Coldness” is the weekly sum of a threshold temperature minus daily max temperature

  17. Temperature and EWM

  18. Cold-only model

  19. Creating a COPD forecast for each PCT Rule-based COPD predictive model Local information/ Feedback/ Evaluation Other weather data e.g. pressure, RH Health data e.g. latest admission data, virus load Health forecaster web interface COPD forecast for each Primary Care Trust (PCT) Average,Above Average,High, Very High

  20. Treating an Exacerbation

  21. Anticipatory Care

  22. Anticipatory Care

  23. Phone call to check: Heating, insulation Diet Medication Social Support Early symptoms Activity levels Depression/anxiety COPD Actions Patient report early symptoms that could herald an exacerbation.

  24. STRATIFICATION OF PATIENTS

  25. Workload / Risk of Admission Forecast Above Average

  26. Workload / Risk of Admission Forecast High

  27. Workload / Risk of Admission Forecast VERY HIGH

  28. Converting risk into action Action 1 (Individual) medication, social support, heating, early symptoms etc. Action 2 (PCT) Increased resource required to deal with larger numbers of high risk. Action 3 (PCT) Increased resource required to deal with moderate admissions. Action 4 (PCT) Baseline resource to attend to small numbers of very high risk group

  29. SUMMARY • By understanding the relationship between health and Cold many clinical conditions may be helped by: • Targeting the vulnerable by place and time • Forecasting periods of increased risk • Delivering interventions that can effectively prevent ill health. • Integrating many partners to deliver

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