FORECASTING EMERGENCY ADMISSIONS IN DEVON - THE...

FORECASTING EMERGENCY ADMISSIONS IN DEVON - THE DEVON PREDICTIVE MODEL

Todd ChenoreSenior information analystNHS Devon

PREDICTIVE MODELLING IN UK HEALTHCARE

Ò Predictive risk models are used for predicting events such as unplanned hospital admissions, which are undesirable, costly and potentially preventable.

Ò Such models have been shown to be superior to other ‘case finding’ approaches, including threshold models and clinical opinion (Curry N. et al. 2005, Allaudeen N. et al. 2011).

Ò Predictive risk models can help the NHS manage: 1. ageing populations2. increasing numbers of people living with long-term

conditions3. rising rates of emergency hospital admissions4. financial pressures

HISTORY OF PREDICTIVE MODELLING IN NHS

Ò Case finding and/or risk stratificationÒ Condition specific models (COPD, falls, etc.)

Ò PARR++ – Inpatient data, readmissions onlyÒ CPM – all emergency admissions, 4 datasetsÒ PRISM – Welsh model Ò SPARRA – Scottish model

KAISER PYRAMID

Relative Risk Population% Emergency admits OP visits A&E visits Interventions

Very High Relative Risk 0.5% 18.6 X average 5.8 X average 8.5 X average Case Management High Relative Risk 0.6% - 5% 5.5 X average 3.8 X average 2.9 X average Disease ManagementModerate Relative Risk 6% - 20% 1.7 X average 1.9 X average 1.4 X average Supported Self Care Low Relative Risk 21% - 100% 0.5 X average 0.6 X average 0.8 X average Prevention & Promotion

5

FREQUENTLY-ADMITTED PATIENTS

0

5

10

15

20

25

30

35

40

45

50

- 5 - 4 - 3 - 2 - 1 Intense year

+ 1 + 2 + 3 + 4

Aver

age

num

ber o

f em

erge

ncy

bed

days

Source: Ann Rowe / Roger HallidayDepartment of Health

6

REACTIVE CASE MANAGEMENT REGRESSION TO THE MEAN

0

5

10

15

20

25

30

35

40

45

50

Aver

age

num

ber o

f em

erge

ncy

bed

days

- 5 - 4 - 3 - 2 - 1 Intense year + 1 + 2 + 3 + 4

7

EMERGING RISKPROACTIVE CASE MANAGEMENT

0

5

10

15

20

25

30

35

40

45

50

Aver

age

num

ber o

f em

erge

ncy

bed

days

- 5 - 4 - 3 - 2 - 1 Intense year

+ 1 + 2 + 3 + 4

DPM - A LOCAL MODEL

Ò Variables chosen from CPM, literature search, and local clinical suggestions

Ò Employed local datasets to capture more riskÒ Employed binary logistic regression

É University of Westminster studyÒ Many variables

É Good for clinical use but not parsimoniousÒ Used significant variables only

É Appropriate?Ò Split sample validationÒ Low cost

NUMBER (%) PATIENTS IN ‘AT RISK’ GROUP PREDICTED BY THEMODEL WHO HAD AN EMERGENCY ADMISSION WITHIN 12 MONTHS

‘At risk’ sub-group Combined Predictive Model (CPM)

Devon Predictive Model (DPM)

200 top-ranked patients (0·03% of registered population) 143/200 (71.5%) 173/200 (86.5%)





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Monthly Data extract from Practice

Secure transfer to PCT Data Warehouse

Generation of Predictive Risk score using DPMData from Secondary Care, DDOC, SWAST, Exeter system, etc.

Identification of Top At-Risk Patients for Admission to Community Virtual Ward

Initial Visit, Consent and Assessment by Community Matron

Areas for action identified and discussed at Complex Care Team Weekly Meeting

and with Patients Own GP etc.

On-going review by the Community Matron as dictated by Predictive Risk

and Current Clinical and Social need -including either Daily/Weekly/Monthly

planned visits

Actions and involvement as necessary by the

Complex Care Team/ GP /Practice, Secondary Care,

Nurse Specialists etc. –Co-ordinated by the

Community Matron for each patient

Patient discharged from CVW if Predictive Risk falls out of top-40/50 – Follow-up via ongoing regular review by

Patients Own GP/Practice and Complex Care Team etc as necessary

Patient and Carers given details for contacting Virtual Ward Office if any problems/early clinical need

Daily communication with Secondary Care, DDOC, SWAST etc - informed of

status and presence of Yellow Folder and Escalation Plan for

each patient in their home and help with crisis

management, admission avoidance and early discharge

Locality Average VW occupancy

Average VW occupancy

chosen from top 0.5% risk

Average VW occupancy

chosen from low risk

Percentage of practices hitting 2011 DPM LES

targets

First quarter net admission

change 2009 to 2011 for top 0.5% cohort*

Change in actual PbR cost associated with net admission

change*

Locality A 107.4% 45.2% 15.5% 65.5% -22.06% -£845,310

Locality B 98.8% 37.8% 21.6% 42.9% -14.24% -£210,758

Locality C 90.3% 28.7% 26.4% 19.2% 3.91% £151,742

Devon Evaluation

ON THE HORIZON

Ò Impactability modelsÉMany not appropriate (refusal, mental health, etc.)É ACS admissionsÉGaps in care

Ò Emerging risk models

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