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

2. What is SPARRA? Scottish Patients At Risk of Readmission and Admission SPARRA is an algorithm for predicting a patient’s risk of emergency inpatient admission to an acute hospital in a particular year

3. 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 Predictor variables Outcome year Historic Period 2001 2002 2003 2004

4. very high 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 – 2 nd 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. SPARRA – The Future Primary Care (General Practice) Hospital Admission s A&E Prescribing Social Work Patient at Risk

14. www.isdscotland.org/ltc