SPARRAPeter Martin

Programme PrincipalLong Term Conditions/Joint Future

Programmes

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

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

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

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

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

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

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

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

Digital story

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

4

Population health managementLong-term conditions

Emergency

admissions

Acutesector

Very High

Lower risk

Medium risk

High risk

SPARRA

coverage

SPARRA – The Future

Primary Care (General Practice)

Hospital Admissio

ns

A&E Prescribing

Social Work

Patient at Risk

www.isdscotland.org/ltc