SPARRALorna Jackson

Head of ProgrammeLong Term Conditions Information Programme

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

SPARRA the ISD service• Risk Scores generated for all relevant patients (SMR1)

• Customers at Board, CHP & practice level receiving data relating to their populations

• Aggregated

– Distribution of risk scores

– Characteristics of risk categories

• Patient-level

– Patient listing with ID, risk scores & factor values

– Threshold option

• Quarterly updates

– NHS email/encrypted email/CD/Navigator

SPARRA – Summary of Current Usage

SPARRA is being used to identify and selects patients suitable for

• Further case management or coordination (dedicated case managers or otherwise)

• GP-lead Local Enhanced Services

– Diseases-specific (eg COPD) or more generic

– Further assessment/reviews/referral

– Anticipatory Care/Self- Management Plans

– Sharing of information eg A&E, Out of Hours

Example – North Ayrshire CHP

Enhanced Service for COPD /LTC patients

Main Features

• GP and DN involvement• SPARRA scores for high-risk patients shared with CHP

– Practice-based patient registers (>60% risk or >50% & COPD)

• Assessment (including SSA)/Multi-disciplinary review of care• COPD

– Individualised exacerbation self-management plan– Assessment/referral to pulmonary rehabilitation– Significant-event analysis

• Flagging and sharing of information with NHS24, ADOC , A&E– Alerts on supporting IT systems/Identification of Case

manager

Use of SPARRA – key points

SPARRA can be used to identify a cohort of patients with a high risk of further admission

– Often these patients have already entered a cycle of repeat admissions

– Further admissions for some may not be preventable

– Patients have multiple LTCs

– Some are close to death & so their requirements are different

– Should always be linked and used in conjunction with local data/intelligence

Development of SPARRAShort-term

• New ‘All ages’ algorithm developed

– Original modelling work repeated/improved on a recent national ‘all-ages’ cohort

– Still based on patients hospitalisation history / largely same factors

– Will identify 2 x high risk patients (28% more 65+)

– To become operational January 2009

– Functionality to distinguish those ‘newly’ identified from ‘previous’ cohort

Longer-term

• A tool applicable to a wider cohort (eg entire registered population)

– Incorporation of other risk factors/datasets eg primary care, prescribing

• Big challenges are finding suitable datasets

– Nationally comprehensive

– Real-time

– Data-sharing issues