prismatic: gp expectations of an emergency admission risk prediction tool
DESCRIPTION
Presentation from Society for Academic Primary Care Annual Conference 2014. Qualitative findings from GP interviews and focus groups regarding introduction of the PRISM Emergency Admission Risk Prediction tool.TRANSCRIPT
Introducing an emergency
admissions predictive risk tool
in primary care: GP
expectations
Mark-Rhys Kingston for the PRISMATIC study team
Why predict Emergency Admissions?
• 18 million+ in UK with Long Term Conditions (LTCs)
• ⅓ of admissions and 60-70% of bed days for LTCs
• Over 70% of NHS and social care budget for LTCs
• 47% rise in emergency admissions (EAs) in 15 years
• Admissions distressing for patients/families
• Patients at different levels of risk can be managed to prevent health deterioration and reduce admissions
High intensity Individual
level
Low intensity Population
level
Welsh Chronic Conditions Model and Framework
House of Care
Informed by risk stratification
NHS Outcomes Framework Domain 2: Enhancing the quality of life for people with LTCs
EA Predictive Risk & GP contracts
Risk stratification a component of emergency admissions enhanced services in GMS contracts in England, Scotland & Wales.
PRISMATIC study
• Aims to describe the processes of introducing a predictive risk stratification model (Prism/WPRS) and to estimate its effects on the delivery of care, patient satisfaction, quality of life and resources. ww.trialsjournal.com/content/14/1/301
Funded by the NIHR HS&DR programme (project number 09/1801/1054).
The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS, or the Department of Health
Baseline Approach
• 3 focus groups - 19 GPs (+9 PMs, 3 PNs)
• Interviews with 11 GPs
• Explored (prior to receipt of Prism):
– Expectations of Prism use and impact
– Concerns over introduction/use
• Thematic analysis informed by...
Normalisation Process Theory
the dynamics of implementing, embedding, and integrating technologies/interventions
Reference: May, C., and Finch, T: Introduction to Normalization Process Theory . PowerPoint 2010. http://www.slideshare.net/CarlRMay/new-introduction-to-npt2
Provisional GP Results Differentiation – participants relate to EAPRS through use of
(disease specific) risk tools and experience of data linkage
Communal Specification:
It’s a good thing if we can prevent people going into hospital, and that’s something we’re very much being pressured to do.
It may help us move from a reactive to a more active model where we identify need and deal with it in advance of a crisis.
One of our real concerns was that other people would use it as a stick to beat us with, and say, “Right, okay, we’ll you’ve got this tool, now what are you doing about those 200 patients?”
Provisional GP Results Individual specification
We’ll involve the whole practice...And we’ll have a look at it in clinical meetings, which we have in any case, and we’ll go from there, I think.
If we allocate a different time to do that, it has to come from somewhere. It has to come from patients’ consultation time.
It’s not going to be very cumbersome; to put the whole system in place and...for it to churn out potential [patients].
Provisional GP Results Internalisation
We have been thinking for a while about looking more in depth at some of the – certain individuals. And I think, you know, this might give us the impetus to actually carry that through.
...it may identify work [or] needs that we feel unable to address. That can be demoralising...and frustrating.
If somebody were to give us a list of our top 100 patients, we’d say, “Well, yeah, you know, we already know about them.”
We have to have a system in place, where there is an alternative....If there’s no alternative, then all of our GPs, all
we’re gonna do is just say, “admit – admit – admit”
Provisional Conclusions
• Good understanding of EAPRS – Supported proactive approaches – Fit with policy
• Seen as advantageous and workable... – but not integrated with current practice
• Challenge of protecting time for use • Desire to trial Prism (longer term adoption?) • Role clarity important • Next steps for longitudinal qualitative work
– Describing how GPs use EAPRS (over time) – Exploring facilitators and barriers to use
