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SPARRA – Recent and Future Developments
Mark Sanderson
Health and Social Care Pathways ISD Scotland
SPARRA - Introduction
• SPARRA (Scottish Patients at Risk of Readmission and Admission) is a tool developed by ISD for predicting a patient’s risk of emergency inpatient admission to an acute hospital in the next year
• SPARRA is typically used to support local teams in providing pro-active, planned and co-ordinated care for patients with frequently changing or complex needs
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
Excel SPARRA Lists
Population Wide Prevention, Health Improvement & Health
Promotion
Interven
tions
Intensive case/care Management
Acute sector
Very High
Disease/care management
Self management
Targeted primary prevention Lower risk
Medium risk
High risk
Kaiser-Permanente Pyramid
SPARRA
- Classic
- All Ages
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 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 = 5,194,000 Population 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
Num
ber o
f Pat
ient
s
Version 3All 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 attendances Polypharmacy
ED attendances
Emergency bed days
LTC related admissions
Emergency / elective / daycase admissions
Prescriptions/admissions indicating particular conditions
New OP attendances for MH
Local SPARRA Model – NHS Ayrshire and Arran
• Development of a local SPARRA model using data sources not available at national level to support the NHS Board’s community ward pilot and to inform longer term national development of SPARRA
• Data sources
– practice
– out of hours
– emergency department
– referrals
– hospitalisation
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 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 Online SPARRA 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, Community Health Partnership (CHP) and/or NHS Board level access to users
SPARRA – The Future Under 16 model
Automation
Version 3
SPARRA – The Future Under 16 model
Automation
Polypharmacy
CMS (Chronic Medication Service) Version
3
SPARRA – The Future Under 16 model
Automation
Polypharmacy
CMS (Chronic Medication Service) Version
3
QOF QP12-14
SPARRA – The Future
iSPARRA
Under 16 model
Automation
Polypharmacy
CMS (Chronic Medication Service) Version
3
QOF QP12-14
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
Under 16 model
Automation
Polypharmacy
CMS (Chronic Medication Service) Version
3
QOF QP12-14
SPARRA – The Future
iSPARRA
Under 16 model
Automation
Polypharmacy
CMS (Chronic Medication Service)
NHS24
Ambulance Service …
… Out of Hours?
Version 3
QOF QP12-14
SPARRA – The Future
iSPARRA
Other outcomes
• Early readmission
• ED attendance
• Admission to care home
Under 16 model
Automation
Polypharmacy
CMS (Chronic Medication Service)
NHS24
Ambulance Service …
… Out of Hours?
Version 3
QOF QP12-14