Predictive risk

OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

Alan brings together his long experience of analysis in the US, and his...

I have to confess that it was with some trepidation that I stepped into the Nuffield Trust one November morning to hear first-hand of the progress on Person-based Resource Allocations (PBRA), designed to allocate about one third of the total budget that will be available to clinical commissioning groups (CCGs).

The thought of trying to keep pace with Martin Bardsley’s technical wizardry around such a key issue was always likely to move me out of my comfort zone in the familiar thought patterns embedded in my basal ganglia and deliver a...

The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

The second was para 4.24 – in response to...

Keen readers of this blog will already know about the importance of risk prediction in health. As my colleague, Dr Geraint Lewis, has pointed out: “neither doctors, nurses nor case managers [are] able to predict which patients [are] at highest risk of readmission to hospital.”

So, if the NHS is to target effectively the ever increasing rate of emergency admissions, it is clear that it needs some help from predictive risk tools.

When the...

In the welcome breather from discussions over the Health and Social Care Bill, Nuffield Trusters have had a distinctly international flavour to our work. Professor Alan Garber, soon to be Provost at Harvard, gave our Rock Carling lecture examining how competition can coexist with developing integrated care. 

In the Q&A he gave some provocative responses: don’t rule out all forms of price competition for clinical care; and give GPs some direct (i.e. personal income) incentives for commissioning well.  For more details...

Earlier this year, the Journal of General Internal Medicine published new research, which showed that neither doctors, nurses nor case managers were able to predict which patients were at highest risk of readmission to hospital. 

This finding is important because if we are to tackle the health problems that manifest as unplanned hospital admissions then we need to be able to predict and prevent these events at the individual level. Unplanned admissions cost the NHS an ...

Our recent conference on risk adjustment focussed on applications where the stakes are highest – namely risk adjustment linked with the funding and reimbursement of health care services.

The morning session included a description of the work on person based resource allocation (PBRA), with Professor Peter Smith (Imperial College London) and Robert Shaw (Department of Health) presenting. Current work on a PBRA formula for the NHS in England will see risk adjustment being used to set GP practice and possibly...

Most interactions you might have with any organisation leave behind a trail of data. In health care, these datasets have many uses and the Nuffield Trust is interested in ways that we can exploit them to inform health policy.

We are particularly interested in how linkage between data sets can reveal a fuller picture of what is happening to people as they use services.  We refer to this as a “data laboratory”, and use this in evaluation and in developing models that predict the likelihood of future events. 

Session three of the Nuffield Trust’s 2011 Health Strategy...

The latest Nuffield Trust report has been a long time in gestation.  It is an important piece of work for us as it signalled our first attempts to link together health and social care information at a person level.

The idea behind this work was very simple.  Can we identify people who are at high risk of needing high cost social care in the coming year?  If we can, then we stand a better chance of targeting prevention strategies to help people now.  The result is better quality of care in the short term and lower costs so...

I was in Lisbon last week to speak at a chronic disease workshop run by the National School of Public Health.  Both the English and the Portuguese health services currently face a significant funding squeeze, and policymakers in the two countries see chronic diseases as an area ripe for potential cost savings.  However, in Portugal the focus is on different chronic diseases from those on which we concentrate in this country. Moreover, the emphasis in Portugal is on reducing the expected costs of these chronic diseases, whereas in the UK we tend to focus on preventing the...