Abstract
BackgroundAn ageing population increases demand on health and social care. New approaches are needed to shift care from hospital to community and general practice. A predictive risk stratification tool (Prism) has been developed for general practice that estimates risk of an emergency hospital admission in the following year. We present a protocol for the evaluation of Prism.Methods/DesignWe will undertake a mixed methods progressive cluster-randomised trial. Practices begin as controls, delivering usual care without Prism. Practices will receive Prism and training randomly, and thereafter be able to use Prism with clinical and technical support. We will compare costs, processes of care, satisfaction and patient outcomes at baseline, 6 and 18 months, using routine data and postal questionnaires. We will assess technical performance by comparing predicted against actual emergency admissions. Focus groups and interviews will be undertaken to understand how Prism is perceived and adopted by practitioners and policy makers. We will model data using generalised linear models and survival analysis techniques to determine whether any differences exist between intervention and control groups. We will take account of covariates and explanatory factors. In the economic evaluation we will carry out a cost-effectiveness analysis to examine incremental cost per emergency admission to hospital avoided and will examine costs versus changes in primary and secondary outcomes in a cost-consequence analysis. We will also examine changes in quality of life of patients across the risk spectrum. We will record and transcribe focus groups and interviews and analyse them thematically. We have received full ethical and R&D approvals for the study and Information Governance Review Panel (IGRP) permission for the use of routine data. We will comply with the CONSORT guidelines and will disseminate the findings at national and international conferences and in peer-reviewed journals.DiscussionThe proposed study will provide information on costs and effects of Prism; how it is used in practice, barriers and facilitators to its implementation; and its perceived value in supporting the management of patients with and at risk of developing chronic conditions.Trial registrationControlled Clinical Trials ISRCTN no. ISRCTN55538212.
Highlights
An ageing population increases demand on health and social care
The proposed study will provide information on costs and effects of predictive risk stratification model (Prism); how it is used in practice, barriers and facilitators to its implementation; and its perceived value in supporting the management of patients with and at risk of developing chronic conditions
New approaches to the management of chronic conditions are needed to shift the balance of care from the acute sector to primary and community sectors [4,5,6] through enhanced local services
Summary
An ageing population increases demand on health and social care. New approaches are needed to shift care from hospital to community and general practice. An ageing population and the associated increasing numbers of people with chronic conditions are placing unprecedented demands on health and social care services, both nationally and internationally [1,2,3]. As doctors either implicitly or explicitly use multiple predictors to assess a patient’s prognosis, multivariable approaches to the design of prediction models are more effective than single predictors [9]. Such prediction models are intended to help clinicians make better decisions by providing more objective estimates of probability as a supplement to other clinical information [9,10]
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