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Risk Stratification - Tools Available
Risk stratification is starting to be used in a number of areas – e.g. risk of developing a long term condition, an acute episode or a complication
For unplanned admissions different tools exist – e.g. PARR ++, Combined Predictive Model, QAdmissions
For 2014-15 – National focus on unplanned hospital admission
(AUA DES)– Local focus on frailty identification (CCM LCS)
Emis Web Risk Stratification Tool
Camden CCG are funding Emis’ Risk Stratification Tool for Camden practices (since July 2014)
Tool consists of:– Risk stratification algorithm (QAdmissions)– Supporting searches & protocols on Emis Web– Documentation & guides
Integrates directly into Emis – can batch add & review results broken down by risk scores
QAdmissions – further detail
Calculates the risk of emergency admission to hospital in next 1 or 2 years
Uses coded data from electronic health record (Emis Web)
Takes into account a range of factors– Demographics & ethnicity– Location & deprivation– Pre-existing medical conditions – Test results (e.g. BMI, haemogloblin)
Calculator & supporting scientific paper available http://www.qadmissions.org/
QAdmissions – recommendations
Run at least quarterly
Review patients by risk scores
Emis categorises these as:– Very high risk > 28%– High risk 18-28%– Medium Risk – 12-18%– Low Risk 7-12%
Identify patients for inclusion either on:– Top 2% for AUA DES (NHS England)– Frailty register/CCM LCS (Camden CCG)
QAdmissions & frailty registerSearches to support the CCM LCS sit in a different folder from the tool (under Camden PCT Information Team)
QAdmissions – where we are at
35 / 37 Camden practices currently using the tool
Available to use at least until March 2016 (we’ll review)
960 patients currently on frailty register (April 2015)
We are encouraging use of the tool to raise this
QAdmissions – issues
Dependent on good quality coded data
Only looking at one data source (Emis)
Doesn’t refresh automatically – needs to be re-run
Focuses on risk of unplanned admission (not risk of frailty / falls)
Risk stratification tools are only estimates – they need to be used alongside local clinical knowledge
QAdmissions – support available
IT & Systems Team, Camden CCG here to support use of this tool
[email protected] or 0203 688 1881
We can provide– Email / telephone advice– Training through
• Practice visits• IT Locality Workshops
Further step by step guides for using tool also available