measuring health and homelessness - in fife dr neil hamlet consultant public health medicine fife...
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Measuring Health and Homelessness
- in FifeDr Neil HamletConsultant Public Health MedicineFife Health & Homelessness [email protected]
Substance Misuse
Dental Care
Foot and skin careAlcohol Abuse
Mental HealthIssues Nutrition and diet
Homelessness
Homelessness - a cross cutting agenda
Community HealthPartnerships Social Work
NHSAcute Services
Registered SocialLandlords
Council HousingDepartments
Voluntary Agencies
Health & Social Care
Integration Bodies
Linkage of Hospital data and Homelessness data in the Kingdom of Fife
Bryan Archibald, Senior Information Officer [email protected]
Bryan [email protected]
The Data Sources
Fife Council• HL1• National data set for each homeless
application• Based on the application (not the number of
homeless individuals)
NHS Fife Acute Hospitals
• eOASIS (patient administration system)
• SMR data submitted to ISD (information Services Division of NHS Scotland)
• Based on Patient Episodes
http://www.scotland.gov.uk/Topics/Statistics/15257/22833
NHS Data (OASIS)• A&E (and Minor Injuries Unit [MIU])• Inpatients & Day cases• Obstetrics• Mental Health Inpatients• Outpatients• Mental Health Outpatients
Under 20 20 to 29 30 to 39 40 to 49 50 and over
-
100
200
300
400
500
600
700
800
2006
2007
2008
2009
2010
2011
Results: A&E
Under 20 20 to 29 30 to 39 40 to 49 50 and over
-
20
40
60
80
100
120
140
160
180
Inpatients & Day cases
Obstetrics Outpatients
Under 20 20 to 24 25 to 29 30 and over
-
50
100
150
200
250
2006 2007
2008 2009
2010 2011
Under 20 20 to 29 30 to 39 40 to 49 50 and over
-
100
200
300
400
500
600
700
So far so good but what does this mean?
• We need a comparator for the homeless population
• Fife’s ‘securely - housed’ population• Try to compare by similar age profile• Started with Fife population 15-64 as our
crude method of ‘standardisation’• Further refinements planned in
‘standardisation process’ • Aiming to compare ‘apples’ with ‘apples’ by
security of housing as defined by HL1 registration
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
200
400
600
800
1,000
1,200
1,400
A&E Attendance Rate per 1,000 Popula-tion
Number of attendances at QMH and VHK
MaleFemale
The value of shared data analysis
‘Insecurely Housed’ ‘Securely Housed’
HL1
Fife
(Age
d 15
- 64
)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Referral From Distribution of A&E Attendances; 2013Source who referred patient to A&E department
Emergency Services GP Other HospitalSelf Referral NHS24
Abuse ?
Pragmatic ?
£££
HL1
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Age Distribution of A&E Attendances; 2013Age of patient attending A&E
Under 20 20 to 29 30 to 3940 to 49 50 and over
Over 50% are under 30 yrs
Over 80% are under 40 yrs
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
50
100
150
200
250
Patient Multiple Attendance Rate per 1,000 PopulationPatients who have attended A&E more than once within
specified year
Male Female
The FrequentFliers
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
50
100
150
200
250
300
Emergency Admission Rate per 1,000 PopulationPatients admitted to hospital as an emergency
£
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
5
10
15
20
25
30
35
40
Multiple Emergency Admission Rate per 1,000 PopulationPatients who have been admitted as an emergency more
than once in specified year
Revolving Hospital Door effect
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
15
30
45
60
75
90
0%
5%
10%
15%
20%
25%
30%
Alcohol-related Admissions rate per 1,000 and % of AdmissionsAdmissions with diagnosis related to alcohol based on ISD definition
%Rate
Rate
per
1,0
00 P
opul
ation
% of Adm
issions
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
10
20
30
40
50
60
0%
5%
10%
15%
20%
Drug Misuse-related Admissions rate per 1,000 and % of AdmissionsAdmissions with diagnosis related to drug misuse based on ISD def-
inition
%
Rate
Rate
per
1,0
00 P
opul
ation
% of Adm
issions
Clear role for Community Safety Partnerships ?
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
10
20
30
40
50
60
70
80
90
100
Emergency Admission Rate relating to Injury & Poisoning per 1,000 PopPatients admitted as emergency relating to injury and poisoning (ICD10 codes
S00 - T99)
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 44)
-
50
100
150
200
250
300
350
400
450
Obstetric Admission Rate per 1,000 PopulationAdmission could be for birth, antenatal or
postnatal care
HL1
Fife
(Age
d 15
- 44
)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Age Distribution of Obstetric Admissions; 2013Age of admitted patient, admission could be for
birth antenatal or postnatal care
Under 20 20 to 24 25 to 29 30 and over
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
20
40
60
80
100
120
Psychiatric Admission Rate per 1,000 PopulationAdmissions to Psychiatric specialty including read-
missions, excludes Learning Disability
MaleFemale
The very tip of the mental distress homeless iceberg
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
0%
5%
10%
15%
20%
25%
30%
35%
40%
% New Outpatient Appointments DNANew appointments who Did Not Attend
(excludes cancellations by hospital or patient)
• Changed address• Fearful to open official mail• Appointment too early• No money for the bus• ‘it won’t do any good’
Access / Expectation
Making a Difference On call nurse manager gets a text alert on her
work phone when a homeless person is seen in Accident and Emergency Dept.
A daily report is now generated listing all the patients in the hospital at 8am who have a temporary homeless accommodation address .
Admissions to Fife Hospitals with Homeless Accommodation AddressBased on Current Homeless Accommodation List & Patient Address in Oasis at time of report refresh
Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
Electiv
e
Medical 2 3 Orthopaedic 0
Surgical 0 1 Theatres 0
Women & Children 0 Total 2 4 0 0 0 0 0 0 0 0 0
Emergenc
y
Medical 8 5 5 Orthopaedic 4 5 3
Surgical 2 Theatres 1 1
Women & Children 5 10 14 Total 20 21 22 0 0 0 0 0 0 0 0
Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150
5
10
15
20
25
Elective
Emergency
Resilience Factors• Supportive friends / family• Strong social networks• Appropriate support services• Savings or access to financial help• Available advice & advocacy• In stable employment• Personal empowerment/capacity