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SPARRA. Peter Martin Programme Principal Long Term Conditions/Joint Future Programmes. What is SPARRA?. S cottish P atients A t R isk of R eadmission and A dmission.

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Peter Martin

Programme Principal

Long Term Conditions/Joint Future Programmes

what is sparra
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

Historic Period






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

example individual with very high predicted probability of admission
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
example individual with very low probability of admission
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
  • 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
development history
Development History


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


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 & 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
sparra the isd service
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




sparra the future

Hospital Admissions



Social Work

Primary Care

(General Practice)

SPARRA – The Future

Patient at Risk