1. SPARRA – Recent and Future
Developments
Mark Sanderson
Health and Social Care Pathways
ISD Scotland

2. 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

3. SPARRA Timeline
Better LTC
Health, National
Delivering Better Action 20:20
for Health Care Plan Vision
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 …
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages
Hospitalisation Hospitalisation
Excel
SPARRA Lists

4. Kaiser-Permanente Pyramid
Intensive
case/care
Management Very Acute SPARRA
High
sector - Classic
Interventions
Disease/care
management High risk - All Ages
Self
management Medium risk
Targeted
primary
prevention Lower risk
Population Wide Prevention,
Health Improvement & Health
Promotion

5. SPARRA Timeline
Better LTC
Health, National
Delivering Better Action 20:20
for Health Care Plan Vision
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 …
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages Version 3
Hospitalisation Hospitalisation Hospitalisation
Prescribing
Emerg Dept
Outpatients
Psychiatric
Excel
SPARRA Lists

6. Datasets and Risk Factors
How many previous How many
emergency admissions prescriptions?
What age is the patient? How many outpatient
has the patient had?
appointments?
Hospitalisation
(Oct 2006 to Sept 2009) What type of
Psychiatric Admission outpatient
(Oct 2006 to Sept 2009) appointments did
the patient have?
Outpatient
Any prescriptions for e.g. (Oct 2008 to Sept 2009)
dementia drugs? Or Emergency Department
Any A&E substance dependence? (Oct 2008 to Sept 2009) Any recent admissions to
attendances in a psychiatric unit ?
the past year? Prescribing
Any previous admissions (Oct 2008 to Sept 2009)
for a long term condition Outcome Year
(such as epilepsy? (Oct 2009 to Sept 2010)
PRE-PREDICTION PERIOD OUTCOME PERIOD

7. Coverage of Version 3
Population of Scotland = 5,194,000
Population covered by SPARRA
Version 3 = 3,500,000
Overlap between
emergency
admission Overlap between
patients and emergency
SPARRA “All admission patients
Ages” = 40% and SPARRA
Version 3 = 95%
Number of Emergency
Population covered by
Admissions in a Year = 342,500
SPARRA “All Ages” = 687,000

8. New and Current Risk Scores
SPARRA - New and Current Risk Scores
500,000
450,000
Number of Patients
400,000
350,000
300,000
Version 3
250,000
All Ages
200,000
150,000
100,000
50,000
0
10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100%
Risk Score
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.

9. 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 …

10. Version 3 Model Factors
Frail Elderly Younger ED
Alcohol/
Age substance
All cohorts misuse
Deprivation related
Emergency /
elective / daycase admissions
Prescriptions
admissions Prescriptions
in specific
BNF chapters LTC related ED for specific
admissions attendances groups of
drugs New OP
Emergency New OP
attendances
bed days Polypharmacy attendances
for MH
LTC
Psychiatric Prescriptions/admissions indicating
admissions particular conditions Deprivation

11. 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

12. SPARRA Timeline
Better LTC
Health, National
Delivering Better Action 20:20
for Health Care Plan Vision
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 …
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages Version 3
Hospitalisation Hospitalisation Hospitalisation
Prescribing
Emerg Dept
Outpatients
Psychiatric
Excel
SPARRA Lists

13. SPARRA Timeline
Better LTC
Health, National
Delivering Better Action 20:20
for Health Care Plan Vision
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 …
2005 2006 2007 2008 2009 2010 2011 2012
Classic All Ages Version 3
Hospitalisation Hospitalisation Hospitalisation
Prescribing
Emerg Dept
Outpatients
Psychiatric
Excel
SPARRA Lists
SPARRA Online

14. 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

15. SPARRA – The Future
Under 16
model
Automation
Version
3

16. SPARRA – The Future
Under 16
model
Automation
Polypharmacy
CMS (Chronic
Medication
Version Service)
3

17. SPARRA – The Future
Under 16
model
Automation
Polypharmacy
CMS (Chronic
Medication
Version Service)
3
QOF QP12-14

18. SPARRA – The Future
Under 16
model
Automation
Polypharmacy
CMS (Chronic
Medication
Version Service)
3
QOF QP12-14
iSPARRA

19. 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

24. SPARRA – The Future
Under 16
model
Automation
Polypharmacy
CMS (Chronic
Medication
Version Service)
3
QOF QP12-14
iSPARRA

25. SPARRA – The Future
Under 16
model
Automation
Polypharmacy
CMS (Chronic
Medication
Version Service)
3
NHS24
Ambulance
Service …
… Out of
Hours?
QOF QP12-14
iSPARRA

26. SPARRA – The Future
Under 16
model
Other outcomes Automation
• Early readmission
• ED attendance Polypharmacy
• Admission to care CMS (Chronic
home Medication
Version Service)
3
NHS24
Ambulance
Service …
… Out of
Hours?
QOF QP12-14
iSPARRA