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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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Sparra

SPARRA

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

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


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


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



Development history
Development History level of care/intervention

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


Sparra case management
SPARRA & Case Management level of care/intervention

  • 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

Digital story level of care/intervention


Sparra the isd service
SPARRA the ISD service level of care/intervention

  • 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 level of care/intervention

coverage


Sparra the future

Hospital Admissions level of care/intervention

A&E

Prescribing

Social Work

Primary Care

(General Practice)

SPARRA – The Future

Patient at Risk


www.isdscotland.org/ltc level of care/intervention