Page 1© Crown copyright 2004 Health Forecasting Home Energy Conference May 11 2005 Dr William Bird...

© Crown copyright 2004

Health Forecasting

Home Energy Conference

May 11 2005

Dr William Bird

Clinical Director, Health Forecasting


THE EFFECT OF COLD ON HEALTH


The Effect of Cold on Hospital Admissions


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PublicExtra winter mortality% increase in mortality for each 1ºC fall from 18ºC Keatinge et al, 1997


Public Prevention Regression coefficients for cold-related mortality from respiratory disease standardised at 70C. *p<0.05 **p<0.01

Encourage

AnorakAnorakAnorakAnorak HatHatWarm

HousingWarm

Housing

-3-3-5*-5*-7**-7**

Shivering +24**

Stationary (>2 mins) +13*

Shivering +24**

Stationary (>2 mins) +13*

AvoidAvoid


Respiratory Effects of Cold

Cold causes bronchoconstrictionCold inhaled air on the lower airwaysFacial cooling

In COPD patients cold bedroom temperatures are related to the development of a ‘cold’ and an exacerbation. This may be related to cooling of nasal passages.

Increase in exacerbations related to cold outdoor temperatures.

Following a fall in temperature there is a lag for respiratory deaths peaking at 12 days.


Keeping the house warm

There is good evidence that cold houses cause increased mortality across all social classes. Indoor temperatures are related to respiratory deaths.

A study in London demonstrated that cold bedroom temperatures are related to increased “common colds” in patients with COPD.

There is no evidence in the misconceptions that cold houses or that sleeping with the bedroom window open is “healthy” despite 40% of elderly doing so.


HEALTH FORECASTING FOR COPD


The Effect of Cold on Different Groups

Elderly, Old Houses, Post Code

COPD, CHD, Chronic Disease,

Health Centre, Out of Hours, Social Services

Managers, A&E, Clinicians

COPD

•PATIENT PATHWAY

•IDENTIFY PATIENTS

•STRATIFY PATIENTS

•BASELINE TREATMENT

•FORECAST

•INTERVENTION


Met Office Winter 04/05 Trial

COPD forecast for PCTs and hospitals to allow anticipatory care.COPD advisory Group chaired by David Halpin

(recent chair of NICE guideline committee).

Workload Forecast for Hospitals based onHistoric dataReal time admission dataEnvironmental factors

Evaluation by London School Hygiene Tropical Medicine funded by DH.


SHA pilot project agreed.

8 Met Office service Developers

Admissions & COPD Prevention.

DoH funded evaluation

COPD project


SERVICE DEVELOPERS

Facilitate Actions

Feedback of current situation

Feedback of service


COPD Burden

A PCT serving a population of 250,000 will have about 14,200 GP consultations every year for people with COPD.

680 patients will be admitted to hospital, accounting for 9800 bed days.

Admission costs about £1700 GP Consultation costs £56


Results so far

One PCT has noted an 85% reduction in COPD admissions.

This could “save” the PCT £1.36 million a year

The forecasts are acting as a catalyst for integrated care between the patient social care, primary care, secondary care and the local authority.

The forecasts are 75% accurate.


COPD AdmissionsPlymouth hospitals

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Positive correlation:

Cold snaps lead to increased COPD admissions, peaking 1-2 weeks later

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Lag Number

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Weekly max 7deg coldness with Weekly totalWeekly “Coldness” measure vs COPD admissions

N.B. “Coldness” is the weekly sum of a threshold temperature minus daily max temperature

Cross-correlations / lags of COPD with weather


Temperature and EWM

Extra Winter Mortality and Max temp.

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Cold-only model

Norfolk Suffolk and Cambridge SHA: first COPD model

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Creating a COPD forecast for each PCT

Rule-based COPD predictive model

Other weather data e.g. pressure, RH

Local information/ Feedback/ Evaluation

Health forecaster web interface

COPD forecast for each Primary Care Trust (PCT)Average, Above Average, High, Very High

Health data e.g.latest admission data,

virus load


Herald period conditions and calendar correction are also taken into account in this model, along with the cold.

Norfolk Suffolk and Cambridge SHA: first COPD model

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Treating an Exacerbation


Anticipatory Care


COPD Actions

Phone call to check:

Heating, insulation Diet Medication Social Support Early symptoms Activity levels Depression/anxiety

Patient report earlysymptoms that couldherald an exacerbation.


STRATIFICATION OF PATIENTS


Above Average

Workload / Risk of Admission Forecast


High



VERY HIGH



PCT (s) Action 1 Action 2 Action 3 Action 4

Very High Workload High Workload Above average Workload

Action 1 (Individual) medication, social support, heating, early symptoms etc.Action 2 (PCT) Increased resource required to deal with larger numbers of high risk.Action 3 (PCT) Increased resource required to deal with moderate admissions.Action 4 (PCT) Baseline resource to attend to small numbers of very high risk group

Converting risk into action


SUMMARY

By understanding the relationship between health and Cold many clinical conditions may be helped by:

Targeting the vulnerable by place and timeForecasting periods of increased riskDelivering interventions that can effectively prevent

ill health. Integrating many partners to deliver

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