© Nuffield Trust Uses of linked administrative data sets Adam Steventon, Nuffield Trust Royal Statistical Society 29 January 2013

© Nuffield Trust Examples of administrative data in England SUS/Hospital Episode Statistics Inpatient hospital use Outpatient hospital use A&E hospital use Diagnoses LA GP General Practice operational systems GP visits/encounters Diagnoses Some test results GP Available nationally PCT NHS community health Contacts with community nursing staff Local authority operational systems Receipt of local authority funded care Assessments of social care need

© Nuffield Trust From: Predictive Models for Health and Social Care: A Feasibility Study Information on social care needs

© Nuffield Trust From: Predictive Models for Health and Social Care: A Feasibility Study Simplifying and sorting

© Nuffield Trust From: Predictive Models for Health and Social Care: A Feasibility Study How to link administrative data sets without using patient identifiable data

© Nuffield Trust From: Predictive Models for Health and Social Care: A Feasibility Study Individual health and social care event timeline over a three-year period

© Nuffield Trust From: Predictive Models for Health and Social Care: A Feasibility Study A few applications Descriptive analyses of social care Overlaps between services EvaluationCase finding

© Nuffield Trust Describing service use © Nuffield Trust

Length of stay in care homes

© Nuffield Trust Transitions in care (75+ in one site)

© Nuffield Trust Overlaps between health and social care © Nuffield Trust

Data linkage Social & secondary care interface

© Nuffield Trust Is this substitution (or something else)?

© Nuffield Trust Evaluation © Nuffield Trust

What is telecare? “the remote, automatic and passive monitoring of changes in an individual’s condition or lifestyle (including emergencies) in order to manage the risks of independent living”

© Nuffield Trust Three whole system demonstrators The poorest county in England, with a dispersed rural population Population of >500,000 46% of the population live in settlements of <3,000 people 99.1% White British 10.3% of the population are aged 65+; 7.2% 75+ and 2.6% % of the population report a limiting long-term illness CORNWALL One of the most deprived areas in the UK Population of 270,442 - GP registered population of 300,000 Population increasing at a higher rate than the London average 2nd most diverse population in the UK - >68% black and minority ethnic (BME) >140 first languages 8.5% of the population are aged % of the population have a limiting long- term illness Highest death rate from stroke and COPD Highest diabetes rate in the UK 2nd highest CHD rate in London NEWHAM Combination of rural and urban populations Population of 1.37m (excluding Medway Unitary Authority). Two areas already piloting telehealth: Ashford/Shepway (population: 211,100) and Dartford/Gravesham/Swanley (population: 210,00) 3.5% BME 17.3% of the population are aged % 75+ and 2.2% 85+ Within the target population, individuals report having an average of 1.6 of the three target conditions of heart failure, COPD, diabetes KENT

© Nuffield Trust Case finding © Nuffield Trust

Predictive Models Identify who will be where on next year’s Kaiser Pyramid

© Nuffield Trust Extending models beyond healthcare

© Nuffield Trust Predictive factors – examples

© Nuffield Trust Original models predicting change at £5k threshold

© Nuffield Trust There are lots of opportunities, but what are the challenges? Lack of consistent information on social care needs Lack of consistent coding Technical difficulty of data extraction (data stored locally) No standard person identifier (NHS number?) Uncertainties about data accuracy And: No information on non-LA funded care

© Nuffield Trust References Bardsley M, Billings J, Dixon J, Georghiou T, Lewis GH, Steventon A. Predicting who will use intensive social care: case finding tools based on linked health and social care data. Age and ageing 2011;40:265–70. Steventon A, Roberts A. Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets. BMC health services research 2012;12:377. Bardsley M, Georghiou T, Chassin L, Lewis G, Steventon A, Dixon J. Overlap of hospital use and social care in older people in England. Journal of health services research & policy 2012;17:133–9.

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