The Department of Health last week announced that it will not be commissioning a national upgrade of two statistical models that have been used in the NHS since 2006 to predict future hospital admissions. The two predictive models – the Patients at Risk of Re-hospitalisation (PARR) and the Combined Predictive Model (CPM) – were funded by the Department of Health in part to make free models available for primary care trusts (PCTs) to choose.
The Nuffield Trust, which has considerable experience in the application of predictive risk modelling techniques in the UK, has today announced that it is considering updating the underlying science upon which the two models are based.
Commenting in response to the Department of Health’s announcement, Nuffield Trust Chief Executive Dr Jennifer Dixon said: ‘Unplanned admissions cost the NHS an estimated £11 billion a year so preventing such admissions is vital. Predictive risk models offer a valuable way of identifying people who are most likely to be admitted to hospital in future, or incur much greater expenditure on social services. Armed with this information it is possible to support those individuals with proactive effective care that not only help people stay well but may also generate net savings for the NHS.
‘It is now well recognised in the NHS that predictive risk tools are essential to use if high quality care is to be offered. This is an important area of development and one that is rapidly evolving. In addition to commercial software solutions, it is important that there be a low cost or free option available to the NHS in future. There are advantages for the NHS Commissioning Board (now NHS England) and others in the health service in being able to access such a standard model. We are exploring a range of models that might be needed in future.’
In a recent letter to PCT chief executives, the Department of Health advised NHS organisations that are using PARR or the Combined Model to consider developing plans now either to upgrade the models themselves or move to alternatives. The letter is available from the Department of Health website.
Notes to editors
- The Patients at Risk of Re-hospitalisation (PARR) and Combined Model (CPM) use statistical formulae to identify high-risk patients based on relationships recorded in routine NHS data. NHS Scotland and NHS Wales have subsequently developed analogous models called SPARRA and PRISM. These four models are part of a family of other predictive tools in use around the world, mainly through commercial or academic providers.
- Like all predictive models, PARR and the Combined Predictive Model need to be recalibrated from time to time. This is to reflect changes in clinical practice, epidemiology, demographics and clinical coding. However, last week the Department of Health announced that it would not be commissioning a “national upgrade” of PARR or the Combined Model.
- The Nuffield Trust has considerable experience in the application of predictive risk modelling techniques in the UK. This includes work on the development of case finding tools discussed above, such as PARR and the Combined Model (the creative team behind the PARR tool is now at the Nuffield Trust); a feasibility study of models that predict future use of social care; work on person-based resource allocation; and a range of national evaluations of interventions to reduce hospital use, including the Whole System Demonstrator Project, integrated care pilots and selected Partnership for Older People Projects (POPP) and Virtual Wards. A recent Nuffield Trust publication: Predictive risk and health care: an overview, explores these issues in more detail. The Nuffield Trust has also created a dedicated section on its website to its predictive risk work.
- Senior Fellow Dr Geraint Lewis' latest blog: PARR++ is dead: long live predictive modelling, provides an overview of the development of predictive risk tools for the NHS, and looks in further detail at the future of the models in light of the announcement from the Department of Health.