Case Management, Admissions, Discharges & Time Release Savings Paul Leak Simon Steer.
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Transcript of Case Management, Admissions, Discharges & Time Release Savings Paul Leak Simon Steer.
Case Management, Case Management, Admissions, Discharges & Admissions, Discharges &
Time Release SavingsTime Release Savings
Paul LeakPaul LeakSimon SteerSimon Steer
Development PathDevelopment Path
Delayed Discharge Delayed Discharge Performance….VariablePerformance….Variable
Emergency Elderly Admission Emergency Elderly Admission Rates…VariableRates…Variable
Historic Investment Patterns…Historic Investment Patterns…VariableVariable
Development RoadDevelopment Road
Long Term ConditionsLong Term Conditions Nairn Case FinderNairn Case Finder Implications For Elderly Care Implications For Elderly Care
Programme Programme and now… Time Release and now… Time Release
SavingsSavings
Delayed Discharge Delayed Discharge 2005/06 Performance2005/06 Performance Target 34; Actual 10Target 34; Actual 10 Six Week Target 19; Actual 3Six Week Target 19; Actual 3 Acute Target 5; Actual 2Acute Target 5; Actual 2 Max Wait 56 daysMax Wait 56 days 384 patients……384 patients……29,582 bed days!29,582 bed days! …….the wrong targets?.the wrong targets? 2004/052004/05…… 264 patients; 27,629 bed days! 264 patients; 27,629 bed days!
90% of Delayed Discharges were Elderly 90% of Delayed Discharges were Elderly Emergency AdmissionsEmergency Admissions
Explanation?Explanation?
The system is moving faster….The system is moving faster….But only to deal with more people But only to deal with more people
being admitted.being admitted.
Match Practice data with Match Practice data with Hospital utilisation data to Hospital utilisation data to predict unplanned admissionspredict unplanned admissionsAge/Sex/Behaviour: GPASSAge/Sex/Behaviour: GPASSChronic Disease Registers: Chronic Disease Registers: GPASSGPASSHospital Admission/Attendance Hospital Admission/Attendance data: PASdata: PASLogistic regressionLogistic regressionAlgorithm Algorithm Probability of admission in next Probability of admission in next twelve monthstwelve months
Lodgehill CasefinderLodgehill Casefinder
Lodgehill CasefinderLodgehill CasefinderROC CurveROC Curve
Area under ROC curve = 0.7943
Se
nsi
tivi
ty
1 - Specificity0.00 0.25 0.50 0.75 1.00
0.00
0.25
0.50
0.75
1.00
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Proportion of patients (%)
Adm
issi
ons/
FCE/
OBDs/
Cos
t
Patient admissionsFCE admissionsBed daysAdmission cost
Lodgehill FindingsLodgehill Findings
CD patients responsible for:CD patients responsible for: 66% Emergency Admission bed days66% Emergency Admission bed days 62% of Emergency Admissions62% of Emergency Admissions 82% Elderly Emergency admissions82% Elderly Emergency admissions
Odds ratio for Emergency admission=3.01 (2.95-3.07)Odds ratio for Emergency admission=3.01 (2.95-3.07)
CD Prevalence:CD Prevalence: 25% of list have CD25% of list have CD 16%<65 years16%<65 years 63%>65 years63%>65 years 78% of DD patients had CD78% of DD patients had CD
Working Hypothosis On Working Hypothosis On CaseloadsCaseloads A 75% match between referral A 75% match between referral
and nomination processes?and nomination processes? Top 101 will be present due to Top 101 will be present due to
complexity/level/cost/fluctuating complexity/level/cost/fluctuating need?need?
The patient care may be led by The patient care may be led by either service, but is likely to either service, but is likely to appear on both caseloads?appear on both caseloads?
Lodgehill FindingsLodgehill Findings
Presence on Community Nursing caseload of Top 101
9
2468
Community Psychiatric NursingCommunity NursingNot Known
Lodgehill FindingsLodgehill Findings
Presence on SW caseload of Top 101
51
24
26
OpenClosedNot Known
Lodgehill FindingsLodgehill Findings
Top 101 as proportion of Nairn SW caseload
92%
8%
OtherTop 101
Lodgehill FindingsLodgehill Findings
Open Cases by Type of Worker
61%
35%
4%
Care AssessorSocial WorkerOccupational Therapist
Admissions From CPN Admissions From CPN CaseloadCaseload
Admissions From CPN caseload
93%
7%
Not admitted
Admitted
Admissions From SW Admissions From SW CaseloadCaseload
2005/06 Admissions from SW Caseload
24%
76%
Admitted
Not Admitted
%CPN Caseload %CPN Caseload By Risk ScoreBy Risk Score
0%
35%
70%
Perc
enta
ge o
f Clie
nt G
roup
0 to 0.
05
0.06 t
o 0.10
0.11 t
o 0.15
0.16 t
o 0.20
0.21 t
o 0.25
0.26 t
o 0.30
0.31 t
o 0.35
0.36 t
o 0.40
0.41 t
o 0.45
0.46 t
o 0.50
0.56 t
o 0.60
Risk Score
Nairn Community Mental Health Team Percentage of Caseload by Risk Score
Social Work CaseloadSocial Work Caseload
Risk Distribution of Social Work Case Load - Percentage
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.00to
0.05
0.05to
0.10
0.10to
0.15
0.15to
0.20
0.20to
0.25
0.25to
0.30
0.30to
0.35
0.35to
0.40
0.40to
0.45
0.45to
0.50
0.50to
0.55
0.55to
0.60
0.60to
0.65
0.65to
0.70
0.70to
0.75
0.75to
0.80
0.80to
0.85
0.85to
0.90Risk
Perc
enta
ge
The Patient QuizThe Patient Quiz
MaleMale 51years51years No admissionsNo admissions No Chronic No Chronic
diseasedisease Moderate Moderate
drinker and drinker and withdrawing withdrawing smokersmoker
Risk 1.4%Risk 1.4%
FemaleFemale 72 years72 years Asthma, COPD, Asthma, COPD,
CHD and LVDCHD and LVD MarriedMarried Ex smoker and Ex smoker and
TTTT 4 admissions 4 admissions
2005/62005/6 Risk 74%Risk 74%
Questions and ConfoundersQuestions and Confounders
Is a low score a measure of Is a low score a measure of prevention?prevention?
Is an admission the trigger Is an admission the trigger stopping subsequent stopping subsequent admission?admission?
What doesn’t get picked up; eg What doesn’t get picked up; eg behaviour issues?behaviour issues?
What about carers?What about carers?
Resource Use IssuesResource Use Issues
How complex are the needs?How complex are the needs? Who is carrying the case?Who is carrying the case? Is it being reviewed?Is it being reviewed? Is resource being freed and Is resource being freed and
targeted?targeted? Eligibility for service?Eligibility for service?