Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review

Abstract

ObjectivesFollowing appropriate validation, clinical prediction rules (CPRs) should undergo impact analysis to evaluate their effect on patient care. The aim of this systematic review is to narratively review and critically appraise CPR impact analysis studies relevant to primary care.SettingPrimary care.ParticipantsAdults and children.InterventionStudies that implemented the CPR compared to usual care were included.Study designRandomised controlled trial (RCT), controlled before–after, and interrupted time series.Primary outcomePhysician behaviour and/or patient outcomes.ResultsA total of 18 studies, incorporating 14 unique CPRs, were included. The main study design was RCT (n=13). Overall, 10 studies reported an improvement in primary outcome with CPR implementation. Of 6 musculoskeletal studies, 5 were effective in altering targeted physician behaviour in ordering imaging for patients presenting with ankle, knee and neck musculoskeletal injuries. Of 6 cardiovascular studies, 4 implemented cardiovascular risk scores, and 3 reported no impact on physician behaviour outcomes, such as prescribing and referral, or patient outcomes, such as reduction in serum lipid levels. 2 studies examined CPRs in decision-making for patients presenting with chest pain and reduced inappropriate admissions. Of 5 respiratory studies, 2 were effective in reducing antibiotic prescribing for sore throat following CPR implementation. Overall, study methodological quality was often unclear due to incomplete reporting.ConclusionsDespite increasing interest in developing and validating CPRs relevant to primary care, relatively few have gone through impact analysis. To date, research has focused on a small number of CPRs across few clinical domains only.

Clinical Prediction Rules: Challenges, Barriers, and Promise

“…A systematic review that examined CPR impact analysis studies relevant to primary care reported that implementation was restricted to a few clinical domains, mainly musculoskeletal, cardiovascular, and respiratory. 7 Of 18 included studies, 10 demonstrated an improvement in primary outcome with CPR use when compared with usual care, with one-half focusing on changing physician behavior in ordering imaging for patients presenting with musculoskeletal injuries. Few studies provided data about the continued use of successful interventions.…”

“…Few studies provided data about the continued use of successful interventions. 7 The issue of methodological quality has recently been addressed with the publication of 2 standardized reporting guidelines for CPR derivation and validation studies and systematic reviews of CPRs. 8,9 These guidelines will have an important role to play in standardizing CPR research and in promoting robust validation of CPRs that should then be prioritized for evaluation in future impact analysis studies.…”

‘Without data, you’re just another person with an opinion’

“…'AI temperature measurement system' uses thermal cameras in that respect [54]. In contrast to the Chiense experience, there is ongoing discussion in the EU whether automated facial recognition breaches GDPR, as the technology fails to meet the regulation's requirement for consent [55,56]. Such example indicate that the legal regulations established on the grounds of social and cultural principles across jurisdictions may lead to differences how Big Data will impact the future development of value-based pricing, the transparency of decision making, and healthcare waste reduction.…”

Validating and Updating GRASP: An Evidence-Based Framework for Grading and Assessment of Clinical Predictive Tools

“…Furthermore, other approaches and frameworks focused on describing methods of to evaluate the postimplementation impact of predictive tools. A framework for predictive tools implementation impact analysis was developed by Wallace [89,90]. A similar framework to evaluate the impact of predictive tools on clinical outcomes was developed by Harris [91].…”

“…However, it is wise to use all available methods, frameworks, approaches, guidelines, and tools to support the GRASP framework through ensuring the quality, robustness, and comprehensiveness of the included evidence. These include Debray framework [77,85], Steyerberg framework [50,51,55,84], Collins approach [56], the TRIPOD statement [86,87] and the CHARMS checklist [88], Wallace framework [89,90],…”