Summary
Predictive Risk Stratification Model: A Trial In Chronic conditions management
Funder: NIHR
Background and study aims
The population has increasing numbers of older people and people who have one or more long-term conditions. This places greater demands on health and social care services. It is recognised that patients with long term conditions are not always managed and treated effectively. Too many are admitted to hospital as emergencies. Also, community services are not always available or don’t work well together. To help improve services, general practitioners (GPs) in Wales are starting to use a scoring system (called Prism) to predict people’s risk of having an emergency hospital admission in the coming year. The system will provide GPs with risk scores for all patients in their practice, with scores ranging from 1 to 100 (very low to very high risk). It is not known how a scoring system which predicts people’s risk of needing emergency treatment will be used in Wales and if it will help patient care. This study aims to find out whether GPs and other health professionals use it and how it affects the way people are cared for. The study has a number of different parts, including discussion groups with health professionals and collecting information about the cost of using the system.
Who can participate?
A random selection of patients from GP patient lists from those practices who have agreed to participate in the study. Any patient who is between the ages of 18 and 100 is eligible to take part. Patients with long-term conditions and those without any diagnosis are being included, so information can be gathered about different experiences. Users of Prism (GPs, practice managers etc), policy makers and commissioners are also invited to take part in interviews or focus groups.
What does the study involve?
The intervention being tested is made up of: Prism software; training for participating practices; clinical support for participating practices provided by two locally appointed ‘GP champions’, a telephone ‘help desk’ during working hours; and a user-friendly handbook of guidance on using Prism including links to available Community Resource Teams which work at locality level to provide multi-disciplinary health and social care support for managing patients. Practices that are recruited begin as ‘controls’, delivering usual care without Prism. Practices receive Prism and training randomly; after which they are able to use Prism with clinical and technical support. The costs, processes of care, patient satisfaction and patient outcomes measured at the beginning of the study and after 6 and 18 months using routinely collected data health and postal questionnaires. To determine how well Prism works, predicted and actual emergency admissions are compared. Qualitative focus groups and interviews are undertaken to understand how Prism is perceived and adopted by practitioners and policy makers.
What are the possible benefits and risks of participating?
This information gained from this study may help improve the way scoring systems are used in the future to benefit patients. The way participants receive their care should not change as a result of being part of the study. The GP surgery may manage patients differently and may select certain patients for referral to specialist services, such as smoking cessation programmes. It is not known at this stage if the Prism system will help to manage patients better and will only know this when the study is complete.
Where is the study run from?
The research is being undertaken by a team from the College of Medicine, Swansea University. The main part of the study will be carried out within the Abertawe Bro Morgannwg NHS Health Board area (Swansea, Bridgend, Neath Port Talbot). In addition professionals will also be interviewed throughout Wales and from outside Abertawe Bro Morgannwg who will not be using Prism, but may have views about it.
When is the study starting and how long is it expected to run for?
Discussion groups with general practitioners and other professionals began in October 2012, with the first recruitment of patients beginning May 2013. Recruitment continued until February 2014. The study ended in March 2016.
Results
Introduction of PRISM increased emergency episodes, hospitalisation and costs across, and within, risk levels without clear evidence of benefits to patients
Contact Details
Trial Manager / Lead Contact: Dr Mark Kingston
Email: M.R.Kingston@Swansea.ac.uk
ISCRTN Number: 55538212 ;