Improving the management of high-risk patients, particularly those with long-term conditions, is an important element of NHS policy. Key to this strategy is finding a way of identifying patients before their condition has worsened and consequently they have experienced avoidable admissions.

In 2005, Essex Strategic Health Authority commissioned The King’s Fund to develop a case-finding algorithm on behalf of the Department of Health, the NHS Modernisation Agency and England’s strategic health authorities. The Department of Health took over the management of this contract in May 2007.

The King’s Fund worked with Health Dialog and New York University to develop the Patients at Risk of Re-hospitalisation (PARR) tool. PARR is a software tool with an easy-to-use interface that uses inpatient data to identify patients at risk of re-hospitalisation within a year. Amended versions were later developed. The latest version, PARR++ was released in November 2007.

In addition, the Combined Predictive Model was developed and released in December 2006. This model uses a wider range of data to enable a PCT to identify people whose condition is deteriorating but who would not yet be picked up by PARR. There is no software interface for this model but full instructions for programmers to build it are available on our website.

These models have provided PCTs with the opportunity to target care more effectively in order to reduce emergency admission rates.

PARR++ and various documents for the Combined Predictive Model can be downloaded free from this website.