NHS handed highly effective tool to help prevent patients being re-admitted to hospital and reduce emergency bed days

An advanced tool that enables primary care trusts (PCTs) to identify patients most at risk of emergency re-admission to hospital was made available to the NHS today.

Freely available to the health service, the computer programme is designed to help PCTs predict the patients most at risk of needing hospital treatment in the next year. PCTs can then better target care for these patients, reducing ill health such that expensive hospital care is needed less.

The tool is a new version of a free computer programme, called Patients at Risk of Re-hospitalisation (PARR), originally developed for the Department of Health in 2006 by a unique partnership between the King's Fund, Health Dialog UK – a subsidiary of Health Dialog Services Corporation – and New York University. More than two thirds of PCTs are believed to be using the original tool, which is considered an important method for identifying patients most at risk of hospital admission.

Five per cent of patients currently account for 49 per cent of NHS acute bed days. Patients with long-term conditions such as congestive heart disease, diabetes and chronic obstructive pulmonary disease (an umbrella term that includes bronchitis and emphysema) are frequently and sometimes unnecessarily admitted to hospital. The new tool, known as PARR++, uses routine inpatient data to predict which patients are at risk of re-admission to hospital in the next 12 months, allowing doctors, nurses and other staff to work with the patient to design better care to reduce the risk of admission in future.

Mark Britnell, Director General of Commissioning and System Management at the Department of Health attended an event today at the King’s Fund that showcased the tool. He said:

'Tools such as PARR++ will play an important part in supporting commissioners to achieve World Class Commissioning. Its ability to proactively identify people at risk who can be offered more timely and appropriate interventions is a fundamental element of an improved commissioning function. Most importantly, it will be patients who will benefit from receiving the most appropriate care in the most appropriate setting.'

King's Fund Director of Policy Dr Jennifer Dixon added:

'Providing better care for people with long-term conditions is one of the biggest challenges facing modern health care. It is critical to offer better care to people who are at risk of emergency admission. This software helps PCTs identify patients who could benefit from interventions such as case management by community matrons and telehealth.

'Because this new tool has been updated to reflect recent health trends and includes more categories of data, it is more accurate in identifying at risk patients than the previous version. This provides PCTs with more potential to target interventions accurately and reduce emergency re-admissions, each of which costs in the region of £2,100 per patient.

‘The old tool produced a limited amount of information about patients at risk. The new tool allows the appropriate clinical staff to look at a wider range of information about each patient and to sort information by condition, age or risk level. Staff will find it considerably easier to use.'

The PARR++ software takes into account a range of factors such as frequency of admission, diagnoses, speciality of consultant seen and socio-demographic characteristics to give each individual a score out of 100 that reflects their future risk of re-admission. That allows a PCT to target appropriate case management or other interventions at those individuals most at risk of emergency re-admission to hospital. This will help reduce the risk of emergency admission in future and enable a better quality of life for patients who are prevented from entering into revolving door emergency admissions.

PARR++ features modifications made in response to feedback from users of the original tool. Not only does it work faster and use more up-to-date information which make it more accurate, it’s also more user friendly and is more flexible in how data can be displayed and the type of reports it can generate.

More about the PARR toolkit

Notes to editors: 

  1. The PARR++ tool was showcased on 13 November 20007 at a King's Fund conference on managing long-term conditions. The tool will be available to download for free on Monday 19 November from the King’s Fund website. The tool on CD can also be pre-ordered from the same web address.
  2. The King's Fund and their partners Health Dialog UK and New York University were commissioned by the Department of Health and the strategic health authorities in 2005 to develop a number of techniques to accurately predict future frequent users of hospital services.
  3. Five per cent of inpatients, many with long-term conditions, account for 49 per cent of all acute bed days. Source: Hospital Episodes Statistics (HES) 2005/06.
  4. For further information or interviews, please contact the King’s Fund press office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  5. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities
  6. Health Dialog UK is a subsidiary of Health Dialog Services Corporation, Boston, USA. The company was founded on the principle that, when individuals are more actively engaged in managing their care with their clinicians, they are more satisfied with their outcomes: quality goes up and costs go down. This is called Shared Decision-Making and is an approach based on the work of the Foundation for Informed Medical Decision Making (FIMDM), a not-for-profit entity founded by Drs John Wennberg and Albert Mulley. Health Dialog uses precision analytics to help identify who can benefit most from Shared Decision-Making through Health Coaching. These analytical tools help identify unwarranted variation and utilisation of health care services so that local health care organisations can target their resources effectively and reduce waste whilst improving quality.