Predicting and Reducing Re-admission to Hospital

A number of PCTs across the country are using PARR, and others have been involved in the development of the Combined Predictive Model. One notable example is Croydon PCT, which recently won several HSJ Awards in recognition of its involvement in this innovative work.

Croydon has been using the Combined Predictive Model in its 'virtual wards' project whereby people identified by the model as having a very high risk of future hospitalisation are put on a ‘virtual ward’. These people are provided with preventive care in their own homes by a multidisciplinary team who use the systems, timetable and staffing of a hospital ward but without the physical building.

Admission to the virtual ward is determined solely by the output of the Combined Predictive Model. Patients’ risk scores are monitored over time and can be used to prompt the virtual ward staff to discharge patients when appropriate – and offer admission to a patient at higher risk.