TY - JOUR 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 SP - 697 LP - 705 DO - 10.1136/bmjqs-2018-007976 VL - 28 IS - 9 AU - Helen Snooks AU - Kerry Bailey-Jones AU - Deborah Burge-Jones AU - Jeremy Dale AU - Jan Davies AU - Bridie Angela Evans AU - Angela Farr AU - Deborah Fitzsimmons AU - Martin Heaven AU - Helen Howson AU - Hayley Hutchings AU - Gareth John AU - Mark Kingston AU - Leo Lewis AU - Ceri Phillips AU - Alison Porter AU - Bernadette Sewell AU - Daniel Warm AU - Alan Watkins AU - Shirley Whitman AU - Victoria Williams AU - Ian Russell Y1 - 2019/09/01 UR - http://qualitysafety.bmj.com/content/28/9/697.abstract N2 - 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. ER -