Transcript Kaiser-Permanente Pyramid SPARRA

SPARRA – Past, Present and Future
Mark Sanderson
Health and Social Care Information Programme
ISD Scotland
The past ….
SPARRA Timeline
Better
Health,
Better
Care
Delivering
for Health
LTC
National
Action
Plan
20:20
Vision
The shift from a health care system geared towards reactive hospital-based treatment of acute
conditions to one which is founded on a preventative, anticipatory approach …
2005
2006
2007
Classic
Hospitalisation
2009
2010
All Ages
Hospitalisation
Excel
SPARRA Lists
2008
2011
2012
Kaiser-Permanente Pyramid
Intensive
Case/care
Management
Interventions
Disease/care
management
Self
management
Targeted
Primary
Prevention
Very
High
High risk
Medium risk
Lower risk
Population Wide Prevention,
Health Improvement & Health
Promotion
Acute
sector
SPARRA
- Classic
- All Ages
…. the present ….
SPARRA Timeline
Better
Health,
Better
Care
Delivering
for Health
LTC
National
Action
Plan
20:20
Vision
The shift from a health care system geared towards reactive hospital-based treatment of acute
conditions to one which is founded on a preventative, anticipatory approach …
2005
2006
2007
Classic
Hospitalisation
2009
2010
All Ages
Hospitalisation
Excel
SPARRA Lists
2008
2011
2012
Version 3
Hospitalisation
Prescribing
Emerg Dept
Outpatients
Psychiatric
Datasets and Risk Factors
How many previous
emergency admissions
has the patient had?
How many
prescriptions?
How many outpatient
appointments?
What age is the patient?
Hospitalisation
(Oct 2006 to Sept 2009)
What type of
outpatient
appointments did
the patient have?
Psychiatric Admission
(Oct 2006 to Sept 2009)
Any A&E
attendances in
the past year?
Any prescriptions for e.g.
dementia drugs? Or
substance dependence?
Any previous admissions
for a long term condition
(such as epilepsy?
PRE-PREDICTION PERIOD
Outpatient
(Oct 2008 to Sept 2009)
Emergency Department
(Oct 2008 to Sept 2009)
Prescribing
(Oct 2008 to Sept 2009)
Any recent admissions to
a psychiatric unit ?
Outcome Year
(Oct 2009 to Sept 2010)
OUTCOME PERIOD
Coverage of Version 3
Population covered by SPARRA
Version 3 = 3,500,000
Overlap between
emergency
admission
patients and
SPARRA “All
Ages” = 40%
Number of Emergency
Admissions in a Year = 342,500
Population of Scotland = 5,194,000
Overlap between
emergency
admission patients
and SPARRA
Version 3 = 95%
Population covered by
SPARRA “All Ages” = 687,000
New and Current Risk Scores
SPARRA - New and Current Risk Scores
500,000
Number of Patients
450,000
400,000
350,000
300,000
Version 3
250,000
All Ages
200,000
150,000
100,000
50,000
0
10-20%
20-30%
30-40%
40-50%
50-60%
60-70%
70-80%
80-90% 90-100%
Risk Score
Note: 2.67m patients have a SPARRA Version 3 risk score of less than 10%. The
equivalent figure is 217,000 for the current tool.
Three Sub-Cohorts
New cohorts …..
• Long Term Conditions
– aged 16-74
• Frail Elderly
– aged 75+
• Younger Emergency Department
– aged 16-55
– At least one ED attendance in previous 12 months
…. new opportunities …
Version 3 Model Factors
Frail Elderly
Age
Alcohol/
substance
misuse
related
admissions
All cohorts
Deprivation
Prescriptions
in specific
BNF chapters
Younger ED
Emergency /
elective / daycase
admissions
LTC related
admissions
Emergency
bed days
ED
attendances
Polypharmacy
New OP
attendances
Prescriptions
for specific
groups of
drugs
New OP
attendances
for MH
LTC
Psychiatric
admissions
Prescriptions/admissions indicating
particular conditions
Deprivation
Local Collaborations
• Development of local algorithms/tools
• Support local initiatives e.g. virtual ward model
• Informs longer term national development of SPARRA
– Use of data sources not available at national level
• Two active projects
– NHS Ayrshire & Arran
– West Lothian CHCP
Use of SPARRA
• Wide variation in take-up and use
• Primarily used for case-finding
• Limited strategic application
• Knowledge café
– NHS Ayrshire and Arran
– Aberdeenshire CHP
– East and Midlothian Anticipatory Care Service
SPARRA Timeline
Better
Health,
Better
Care
Delivering
for Health
LTC
National
Action
Plan
20:20
Vision
The shift from a health care system geared towards reactive hospital-based treatment of acute
conditions to one which is founded on a preventative, anticipatory approach …
2005
2006
2007
Classic
Hospitalisation
2009
2010
All Ages
Hospitalisation
Excel
SPARRA Lists
2008
2011
2012
Version 3
Hospitalisation
Prescribing
Emerg Dept
Outpatients
Psychiatric
SPARRA Timeline
Better
Health,
Better
Care
Delivering
for Health
LTC
National
Action
Plan
20:20
Vision
The shift from a health care system geared towards reactive hospital-based treatment of acute
conditions to one which is founded on a preventative, anticipatory approach …
2005
2006
2007
Classic
Hospitalisation
2008
2009
2010
All Ages
Hospitalisation
2011
2012
Version 3
Hospitalisation
Prescribing
Emerg Dept
Outpatients
Psychiatric
Excel
SPARRA Lists
SPARRA Online
SPARRA Online
• SPARRA online offers secure user-friendly access to
SPARRA data through a Business Objects universe
• It provides patient listings and risk score history
• It can be used to generate own queries or use the pregenerated reports
• The security settings allow access to GP, CHP and/or NHS
Board level access to users
• Roll-out at an advanced stage
…. and the future
SPARRA – The Future
iSPARRA
Version
3
iSPARRA
• Incorporate SPARRA into a Management Information
System
• Wider benefits of risk stratification
• User-friendly front-end, dashboard and drill-down
• Access to the full Version 3 dataset
SPARRA – The Future
iSPARRA
Version
3
SPARRA – The Future
iSPARRA
Version
3
Data sources
NHS24
SAS …
… Out of
Hours?
SPARRA – The Future
iSPARRA
Version
3
Data sources
NHS24
SAS …
… Out of
Hours?
Under 16
model
Automation
SPARRA – The Future
iSPARRA
Version
3
Data sources
NHS24
SAS …
Benefits
… Out of
Hours?
Under 16
model
Evaluation
Automation
SPARRA – The Future
iSPARRA
Version
3
Data sources
NHS24
SAS …
Benefits
… Out of
Hours?
Under 16
model
Polypharmacy
Evaluation
Automation
SPARRA – The Future
iSPARRA
Other outcomes
• Early readmission
Risk prediction
• ED attendance
Benefits
• Admission to care
home
Version
3
Data sources
NHS24
SAS …
… Out of
Hours?
Under 16
model
Polypharmacy
Evaluation
Automation
SPARRA – The Future
What
Else?
iSPARRA
Other outcomes
• Early readmission
Risk prediction
• ED attendance
Benefits
• Admission to care
home
Version
3
Data sources
NHS24
SAS …
… Out of
Hours?
Under 16
model
Polypharmacy
Evaluation
Automation
Further Information
Website: www.isdscotland.org/sparra
E-mail: [email protected]