the past …
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SPARRA – Past, Present and Future Mark Sanderson Health and Social Care Information Programme ISD Scotland. The past …. 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 …. - PowerPoint PPT PresentationTRANSCRIPT
SPARRA – Past, Present and Future
Mark Sanderson
Health and Social Care Information ProgrammeISD Scotland
The past ….
SPARRA Timeline
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages
Hospitalisation Hospitalisation
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 …
Delivering for Health
Better Health, Better Care
LTC National Action Plan
20:20 Vision
ExcelSPARRA Lists
Population Wide Prevention, Health Improvement & Health
Promotion
Inte
rventio
ns
Intensive Case/care Management
Emergency
admissions
Acutesector
Very High
Disease/caremanagement
Selfmanagement
Targeted Primary Prevention Lower risk
Medium risk
High risk
Kaiser-Permanente Pyramid
SPARRA
- Classic
- All Ages
…. the present ….
SPARRA Timeline
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages Version 3
Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric
Hospitalisation Hospitalisation
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 …
Delivering for Health
Better Health, Better Care
LTC National Action Plan
20:20 Vision
ExcelSPARRA Lists
Datasets and Risk Factors
Outpatient(Oct 2008 to Sept 2009)
Emergency Department(Oct 2008 to Sept 2009)
Prescribing (Oct 2008 to Sept 2009)
Outcome Year(Oct 2009 to Sept 2010)
OUTCOME PERIOD
Hospitalisation(Oct 2006 to Sept 2009)
PRE-PREDICTION PERIOD
Psychiatric Admission(Oct 2006 to Sept 2009)
Any recent admissions to a psychiatric unit ?
Any A&E attendances in the past year?
What type of outpatient
appointments did the patient have?
Any prescriptions for e.g. dementia drugs? Or
substance dependence?
How many outpatient appointments?
What age is the patient?
How many previous emergency admissions
has the patient had?
How many prescriptions?
Any previous admissions for a long term condition
(such as epilepsy?
Coverage of Version 3
Population of Scotland = 5,194,000Population covered by SPARRA
Version 3 = 3,500,000
Number of Emergency Admissions in a Year = 342,500
Population covered by SPARRA “All Ages” = 687,000
Overlap between emergency admission patients and SPARRA “All Ages” = 40%
Overlap between emergency admission patients and SPARRA Version 3 = 95%
New and Current Risk Scores
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.
SPARRA - New and Current Risk Scores
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100%
Risk Score
Nu
mb
er o
f P
atie
nts
Version 3
All Ages
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
All cohorts
Younger ED
LTC
Age
Prescriptions in specific BNF chapters
Deprivation
Alcohol/ substance misuse related admissions
Prescriptions for specific groups of drugs
Psychiatric admissions Deprivation
New OP attendancesPolypharmacy
ED attendances
Emergency bed days
LTC related admissions
Emergency / elective / daycase admissions
Prescriptions/admissions indicating particular conditions
New OP attendances for MH
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
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages Version 3
Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric
Hospitalisation Hospitalisation
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 …
Delivering for Health
Better Health, Better Care
LTC National Action Plan
20:20 Vision
ExcelSPARRA Lists
SPARRA Timeline
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages Version 3
Hospitalisation Prescribing Emerg Dept Outpatients Psychiatric
Hospitalisation Hospitalisation
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 …
Delivering for Health
Better Health, Better Care
LTC National Action Plan
20:20 Vision
Excel
SPARRA OnlineSPARRA Lists
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 pre-generated 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
Version
iSPARRA
Tool
s and
acc
essib
ility
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
Version
iSPARRA
Tool
s and
acc
essib
ility
3
SPARRA – The Future
Version
iSPARRA
Tool
s and
acc
essib
ility
Data sourcesNHS24
SAS …
… Out of Hours?
3
SPARRA – The Future
Version
iSPARRA
Tool
s and
acc
essib
ility
SPARRA Version
3
Under 16 model
Automation
Data sourcesNHS24
SAS …
… Out of Hours?
3
SPARRA – The Future
Version
iSPARRA
Tool
s and
acc
essib
ility
SPARRA Version
3
Under 16 model
Automation
Data sourcesNHS24
SAS …
… Out of Hours?B
enefits
Evaluation
3
SPARRA – The Future
Version
iSPARRA
Tool
s and
acc
essib
ility
Pres
crib
ing
data
SPARRA Version
3
Under 16 model
Automation
Polypharmacy
Data sourcesNHS24
SAS …
… Out of Hours?B
enefits
Evaluation
3
SPARRA – The Future
Version
iSPARRA
Tool
s and
acc
essib
ility
Pres
crib
ing
data
Other outcomes
• Early readmission
• ED attendance
• Admission to care home
Risk prediction
SPARRA Version
3
Under 16 model
Automation
Polypharmacy
Data sourcesNHS24
SAS …
… Out of Hours?B
enefits
Evaluation
3
SPARRA – The Future
Version
iSPARRA
Tool
s and
acc
essib
ility
Pres
crib
ing
data
Other outcomes
• Early readmission
• ED attendance
• Admission to care home
Risk prediction
SPARRA Version
3
Under 16 model
Automation
What Else?
Polypharmacy
Data sourcesNHS24
SAS …
… Out of Hours?B
enefits
Evaluation
3