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Health Forecasting
Home Energy Conference
May 11 2005
Dr William Bird
Clinical Director, Health Forecasting
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THE EFFECT OF COLD ON HEALTH
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The Effect of Cold on Hospital Admissions
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PublicExtra winter mortality% increase in mortality for each 1ºC fall from 18ºC Keatinge et al, 1997
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Public Prevention Regression coefficients for cold-related mortality from respiratory disease standardised at 70C. *p<0.05 **p<0.01
Encourage
AnorakAnorakAnorakAnorak HatHatWarm
HousingWarm
Housing
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Shivering +24**
Stationary (>2 mins) +13*
Shivering +24**
Stationary (>2 mins) +13*
AvoidAvoid
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Respiratory Effects of Cold
Cold causes bronchoconstrictionCold inhaled air on the lower airwaysFacial cooling
In COPD patients cold bedroom temperatures are related to the development of a ‘cold’ and an exacerbation. This may be related to cooling of nasal passages.
Increase in exacerbations related to cold outdoor temperatures.
Following a fall in temperature there is a lag for respiratory deaths peaking at 12 days.
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Keeping the house warm
There is good evidence that cold houses cause increased mortality across all social classes. Indoor temperatures are related to respiratory deaths.
A study in London demonstrated that cold bedroom temperatures are related to increased “common colds” in patients with COPD.
There is no evidence in the misconceptions that cold houses or that sleeping with the bedroom window open is “healthy” despite 40% of elderly doing so.
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HEALTH FORECASTING FOR COPD
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The Effect of Cold on Different Groups
Elderly, Old Houses, Post Code
COPD, CHD, Chronic Disease,
Health Centre, Out of Hours, Social Services
Managers, A&E, Clinicians
COPD
•PATIENT PATHWAY
•IDENTIFY PATIENTS
•STRATIFY PATIENTS
•BASELINE TREATMENT
•FORECAST
•INTERVENTION
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Met Office Winter 04/05 Trial
COPD forecast for PCTs and hospitals to allow anticipatory care.COPD advisory Group chaired by David Halpin
(recent chair of NICE guideline committee).
Workload Forecast for Hospitals based onHistoric dataReal time admission dataEnvironmental factors
Evaluation by London School Hygiene Tropical Medicine funded by DH.
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SHA pilot project agreed.
8 Met Office service Developers
Admissions & COPD Prevention.
DoH funded evaluation
COPD project
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SERVICE DEVELOPERS
Facilitate Actions
Feedback of current situation
Feedback of service
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COPD Burden
A PCT serving a population of 250,000 will have about 14,200 GP consultations every year for people with COPD.
680 patients will be admitted to hospital, accounting for 9800 bed days.
Admission costs about £1700 GP Consultation costs £56
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Results so far
One PCT has noted an 85% reduction in COPD admissions.
This could “save” the PCT £1.36 million a year
The forecasts are acting as a catalyst for integrated care between the patient social care, primary care, secondary care and the local authority.
The forecasts are 75% accurate.
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COPD AdmissionsPlymouth hospitals
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Positive correlation:
Cold snaps lead to increased COPD admissions, peaking 1-2 weeks later
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Lag Number
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Upper Confidence Limit
Lower Confidence Limit
Weekly max 7deg coldness with Weekly totalWeekly “Coldness” measure vs COPD admissions
N.B. “Coldness” is the weekly sum of a threshold temperature minus daily max temperature
Cross-correlations / lags of COPD with weather
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Temperature and EWM
Extra Winter Mortality and Max temp.
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Cold-only model
Norfolk Suffolk and Cambridge SHA: first COPD model
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Actuals
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Creating a COPD forecast for each PCT
Rule-based COPD predictive model
Other weather data e.g. pressure, RH
Local information/ Feedback/ Evaluation
Health forecaster web interface
COPD forecast for each Primary Care Trust (PCT)Average, Above Average, High, Very High
Health data e.g.latest admission data,
virus load
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Herald period conditions and calendar correction are also taken into account in this model, along with the cold.
Norfolk Suffolk and Cambridge SHA: first COPD model
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Actuals
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Treating an Exacerbation
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Anticipatory Care
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Anticipatory Care
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COPD Actions
Phone call to check:
Heating, insulation Diet Medication Social Support Early symptoms Activity levels Depression/anxiety
Patient report earlysymptoms that couldherald an exacerbation.
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STRATIFICATION OF PATIENTS
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Above Average
Workload / Risk of Admission Forecast
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High
Workload / Risk of Admission Forecast
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VERY HIGH
Workload / Risk of Admission Forecast
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PCT (s) Action 1 Action 2 Action 3 Action 4
Very High Workload High Workload Above average Workload
Action 1 (Individual) medication, social support, heating, early symptoms etc.Action 2 (PCT) Increased resource required to deal with larger numbers of high risk.Action 3 (PCT) Increased resource required to deal with moderate admissions.Action 4 (PCT) Baseline resource to attend to small numbers of very high risk group
Converting risk into action
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SUMMARY
By understanding the relationship between health and Cold many clinical conditions may be helped by:
Targeting the vulnerable by place and timeForecasting periods of increased riskDelivering interventions that can effectively prevent
ill health. Integrating many partners to deliver