Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Background With a higher proportion of older people in the UK population, new approaches are needed to reduce emergency hospital admissions, thereby shifting care delivery out of hospital when possible and safe. Study aim To evaluate the introduction of predictive risk stratification in primary care...

Full description

Saved in:

Bibliographic Details
Published in:	Health services and delivery research 2018-01, Vol.6 (1), p.1-164
Main Authors:	Snooks, Helen, Bailey-Jones, Kerry, Burge-Jones, Deborah, Dale, Jeremy, Davies, Jan, Evans, Bridie, Farr, Angela, Fitzsimmons, Deborah, Harrison, Jane, Heaven, Martin, Howson, Helen, Hutchings, Hayley, John, Gareth, Kingston, Mark, Lewis, Leo, Phillips, Ceri, Porter, Alison, Sewell, Bernadette, Warm, Daniel, Watkins, Alan, Whitman, Shirley, Williams, Victoria, Russell, Ian T
Format:	Article
Language:	eng
Subjects:	chronic disease clinical prediction rule emergency health services primary care risk prediction stepped wedge
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background With a higher proportion of older people in the UK population, new approaches are needed to reduce emergency hospital admissions, thereby shifting care delivery out of hospital when possible and safe. Study aim To evaluate the introduction of predictive risk stratification in primary care. Objectives To (1) measure the effects on service usage, particularly emergency admissions to hospital; (2) assess the effects of the Predictive RIsk Stratification Model (PRISM) on quality of life and satisfaction; (3) assess the technical performance of PRISM; (4) estimate the costs of PRISM implementation and its effects; and (5) describe the processes of change associated with PRISM. Design Randomised stepped-wedge trial with economic and qualitative components. Setting Abertawe Bro Morgannwg University Health Board, south Wales. Participants Patients registered with 32 participating general practices. Intervention PRISM software, which stratifies patients into four (emergency admission) risk groups; practice-based training; and clinical support. Main outcome measures Primary outcome – emergency hospital admissions. Secondary outcomes – emergency department (ED) and outpatient attendances, general practitioner (GP) activity, time in hospital, quality of life, satisfaction and costs. Data sources Routine anonymised linked health service use data, self-completed questionnaires and staff focus groups and interviews. Results Across 230,099 participants, PRISM implementation led to increased emergency admissions to hospital [Δ L = 0.011, 95% confidence interval (CI) 0.010 to 0.013], ED attendances (Δ L = 0.030, 95% CI 0.028 to 0.032), GP event-days (Δ L = 0.011, 95% CI 0.007 to 0.014), outpatient visits (Δ L = 0.055, 95% CI 0.051 to 0.058) and time spent in hospital (Δ L = 0.029, 95% CI 0.026 to 0.031). Quality-of-life scores related to mental health were similar between phases (Δ = –0.720, 95% CI –1.469 to 0.030); physical health scores improved in the intervention phase (Δ = 1.465, 95% CI 0.774 to 2.157); and satisfaction levels were lower (Δ = –0.074, 95% CI – 0.133 to –0.015). PRISM implementation cost £0.12 per patient per year and costs of health-care use per patient were higher in the intervention phase (Δ = £76, 95% CI £46 to £106). There was no evidence of any significant difference in deaths between phases (9.58 per 1000 patients per year in the control phase and 9.25 per 1000 patients per year in the intervention phase). PRISM showed good general tech
ISSN:	2050-4349 2050-4357