RT Journal Article
SR Electronic
T1 Effects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trial
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 697
OP 705
DO 10.1136/bmjqs-2018-007976
VO 28
IS 9
A1 Helen Snooks
A1 Kerry Bailey-Jones
A1 Deborah Burge-Jones
A1 Jeremy Dale
A1 Jan Davies
A1 Bridie Angela Evans
A1 Angela Farr
A1 Deborah Fitzsimmons
A1 Martin Heaven
A1 Helen Howson
A1 Hayley Hutchings
A1 Gareth John
A1 Mark Kingston
A1 Leo Lewis
A1 Ceri Phillips
A1 Alison Porter
A1 Bernadette Sewell
A1 Daniel Warm
A1 Alan Watkins
A1 Shirley Whitman
A1 Victoria Williams
A1 Ian Russell
YR 2019
UL http://qualitysafety.bmj.com/content/28/9/697.abstract
AB Aim We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.Methods Randomised stepped wedge trial with 32 general practices in one Welsh health board. The intervention comprised: PRISM software; practice-based training; clinical support through two ‘general practitioner (GP) champions’ and technical support. The primary outcome was emergency hospital admissions.Results Across 230 099 participants, PRISM implementation increased use of health services: emergency hospital admission rates by 1 % when untransformed (while change in log-transformed rate ΔL=0.011, 95% CI 0.010 to 0.013); emergency department (ED) attendance rates by untransformed 3 % (while ΔL=0.030, 95% CI 0.028 to 0.032); outpatient visit rates by untransformed 5 % (while ΔL=0.055, 95% CI 0.051 to 0.058); the proportion of days with recorded GP activity by untransformed 1 % (while ΔL=0.011, 95% CI 0.007 to 0.014) and time in hospital by untransformed 3 % (while ΔL=0.029, 95% CI 0.026 to 0.031). Thus NHS costs per participant increased by £76 (95% CI £46 to £106).Conclusions Introduction of PRISM resulted in a statistically significant increase in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS.