Our approach

Using routinely collected data from Central Halifax PCN (no extra collections required) we wanted to learn:

• How many people died in calendar year 2023?

• How old were they?

• How many had palliative care codes associated with them?

• How many did we miss that could have been detected prospectively?

Through a combination of data engineering, machine learning techniques and clinical engagement we produced a simple risk prediction model that identifies people likely to die in the next twelve months which we validated against historic outcomes for the PCN.

This tool was then applied against a recent snapshot (February 2024) of the current registered PCN population which produced a re-identifiable list of people to review who were in the top 1% highest risk category. Where appropriate, these individuals were referred onward for to the most appropriate clinician/ carer for ACP conversations.

GSF