Julia Perry – Risk Analysis

Risk Analysis & the Risk Stratification Tool Julia Perry NP – 5th Ave Family Practice

Aim: Identify high risk Maori population at 5th Ave Family Practice using the Risk Stratification tool u

Tool determines the risk of hospital admission in the next 12 months – patient provided with a ‘risk score’

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Risk score is based on an algorithm of multiple factors – demographics, contact with health services & presence of comorbidities.

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5th Ave analysis also included: 1

Classification of comorbidity (anything), plus COPD/CVD/Diabetes or All three

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Number of days to last consult - past 12 mths

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Number of GP consults - in past 24 mths

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Emergency Department (ED) attendance

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Self referrals

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GP/nurse referrals

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number of ED presentations past 24 months

Out Patient Department (OPD) consults - past 12 months (could include clinic appts, DNs, Mental Health & Addiction, counselling etc)

Find your ‘Risk Analysis’ population u

Data is presented as an excel spreadsheet – at 1st glance ‘overwhelming!’

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Need education session & 1-2 hours

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Start with the ‘Risk Profile’ & ‘Summary’ pages

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Total enrolled Maori population = 1369

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Chose level of risk score – 5th Ave chose risk score >40 (*40% chance of admission in next 12 months)

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Risk analysis population = 46

Determine the reasons why this population have been allocated a high risk score

5th Ave Maori population with high risk score >40 = 46

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Analysis of spreadsheet showed: u

17% patients classified with any comorbidity

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3 patients had COPD, 12 CVD, and 11 DM

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Days until last consult - >3mths (15), >6mths (3), >12mths (1)

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Number GP consults 24mths – 78% patients seen >20x

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ED presentation – 63% self referred, 15% GP referred, 59% >1 ED presentation

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OPD contacts – 96% patients seen by OPD services in past 12 mths

*Age range 0-5yrs (3), 5-18yrs (3), 18-65yrs (26), 65yrs+ (14) *4 deceased since risk analysis performed

Review & Results u

>50% had multiple comorbidities, were eligible but not enrolled CarePlus funding

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Overall classification disease/condition/diagnosis in notes poor, especially for Mental Health conditions

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48% patients had Mental Health issues (eg. diagnosis, medications, counselling, contact with A&D services, documented depression/anxiety in notes)

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12% prescribed >8 regular medications – polypharmacy

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0-5yr – multiple number GP consults/ED presentations – nil disease/diagnosis classified

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5-18yr – multiple number of OPD contacts especially counselling – nil disease/diagnosis classified

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18-65yr – high numbers OPD contacts (>80%) & ED presentations (35%)

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65yr+ - high number of GP consults (all but 2 pts seen >24x) & ED presentations

What are we going to do at 5th Ave?

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Develop care/management plans targeting early intervention for all patients with high risk scores

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Enrol eligible patients in funded management programmes

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Develop ‘targeted programmes’ for Mental Health, Vulnerable children

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Update recalls/alerts/referrals

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Improve documentation & classifications in clinical notes

Lastly – the research – NSW Agency for Clinical Innovation 2015

Review undertaken by NSW government – 20 RS tools Key findings were that Risk Stratification tools u

Can successfully predict events such as unplanned hospital admissions

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Central to linking those at highest risk to the most appropriate evidence based care strategies

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Engagement of clinicians in tool selection, implementation, refinement & end use was a major enabler to success

Risk Stratification in NSW: Summary Report. A discussion paper for NSW Health’s Approach to Risk Stratification (2015). www.aci.health.nsw.gov.au