1 SPARRA MD Mike Muirhead, ISD Scotland SPD Network conference. 4 th September, 2008

2 SPARRA Scottish Patients At Risk of Re- admission and Admission Scottish Patients At Risk of Re- admission and Admission ( cf PARR model – King’s Fund)

3 Aim of SPARRA MD Identify those individuals most at risk of psychiatric re-admission to hospital in next twelve monthsIdentify those individuals most at risk of psychiatric re-admission to hospital in next twelve months

4 Aim of SPARRA MD Identify those individuals most at risk of psychiatric re-admission to hospital in next twelve monthsIdentify those individuals most at risk of psychiatric re-admission to hospital in next twelve months Re-admission not admissionRe-admission not admission

5 Personality Disorder – some inpatient stats.

6 4.0% of patients admitted in 06/07 were for PD4.0% of patients admitted in 06/07 were for PD 4.8% of total episodes in 06/07 were for personality disorder.4.8% of total episodes in 06/07 were for personality disorder. Frequency of admissionFrequency of admission –72 % patients admitted once –15% patients admitted twice –13% patients admitted 3 or more times 2.5% of total beddays were for PD.2.5% of total beddays were for PD.

7 PD hospital episodes (06/07); rate/1000 pop by age

8 Two separate models

9 1. Psychiatric inpatient admission based on SMR04 records 2. Psychiatrically related emergency admission to acute hospital based on SMR01 records

10 Two separate models 1. Psychiatric inpatient admission based on SMR04 records 2. Psychiatrically related emergency admission to acute hospital based on SMR01 records

11 1 st April 2006 Predictor variables Outcome year Developing the predictive model Time Period Model is based on previous 3 years of hospital admissions

12 1 st April 2006 Predictor variables Outcome year Developing the predictive model Time Period Model is based on previous 3 years of hospital admissions 38,000 patients (15=+)

13 SMR04 model: significant predictor variables

14 SMR04 model: significant predictor variables Age (risk tails off after age 50) Previous admissions (powerful effect) Recency of admission (powerful effect) Total bed days (moderate effect) Most recent diagnosis (moderate effect) Urban / rural (slight effect)

15 SMR04 model: significant predictor variables Age (risk tails off after age 50) Previous admissions (powerful effect) Recency of admission (powerful effect) Total bed days (moderate effect) Most recent diagnosis (moderate effect) Urban / rural (slight effect) Not significant: deprivation, NHS Board, gender, formal admission, number of different diagnoses

16 Relationship between diagnosis and likelihood of admission

17 5% of cohort

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21 SPARRA model: Example I Very high risk (78%). Male aged 25-29Male aged admissions.6+ admissions. 120 bed days.120 bed days. Most recent diagnosis: Personality disorderMost recent diagnosis: Personality disorder

22 SPARRA model: Example II High risk (65%). Female aged 40-44Female aged admissions.6+ admissions. 60 bed days.60 bed days. Diagnosis: schizophrenia.Diagnosis: schizophrenia.

23 SPARRA model: Example III Low risk (20%) Female aged 37.Female aged admission.1 admission. 15 days.15 days. Diagnosis: mood affective disorder.Diagnosis: mood affective disorder.

24 What’s next? Piloting and evaluation of model –Is it helpful? –Does it add anything? Offer to all NHS boards Ensure integration with “classic” SPARRA Address data completeness/timeliness issues Extend the model – prescribing data & primary care (longer term)

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27 Personality disorders F60 Specific personality disordersF60 Specific personality disorders F61 Mixed and other personality disordersF61 Mixed and other personality disorders F62 Enduring personality changes, not attributable to brain damage and diseaseF62 Enduring personality changes, not attributable to brain damage and disease F63 Habit and impulse disordersF63 Habit and impulse disorders F64 Gender identity disordersF64 Gender identity disorders F65 Disorders of sexual preferenceF65 Disorders of sexual preference F66 Psychological and behavioural disorders associated with sexual development and orientationF66 Psychological and behavioural disorders associated with sexual development and orientation F68 Other disorders of adult personality and behaviourF68 Other disorders of adult personality and behaviour F69 Unspecified disorder of adult personality and behaviourF69 Unspecified disorder of adult personality and behaviour