Variability in selecting patients to manage in the community: a service evaluation of community matron's case-finding strategies

Hall, S; Kulendran, M; Sadek, Ahmed; Green, S; Lusignan, Simon de

doi:10.1093/fampra/cmq095

Cited by 4 publications

(16 citation statements)

References 12 publications

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“…Of the 11 studies, eight were European, consisting of four studies (and five papers) from England, 48,49,52,54,55 two (related studies) in Germany, 27,46 one in Scotland 44 and one in Spain. 53 Three studies were undertaken in North America, one in Canada 45 and two in the USA (yielding three papers).…”

Section: Settingsmentioning

confidence: 99%

“…46 Three wholly qualitative studies were included, 27,53,54 with qualitative methods also featuring in two others.…”

Section: Study Designsmentioning

confidence: 99%

“…The Patients at Risk of Re-hospitalisation (PARR) tool was used in five studies. 48,49,52,54,55 PARR uses data on prior hospitalisations to predict risk of rehospitalisation and, hence, calculates risk only for those patients with a previous admission. The combined predictive model was reported in three studies, 48,49,52 with single references to the Elder Risk Assessment (ERA), 50 Case Smart Suite Germany, 46 Length of stay, Acuity, Comorbidities, ED visits in previous 6 months (LACE), 45 Nairn Case Finder, 44 High Impact User Manager 52 and Adjusted Clinical Groups (ACGs).…”

Section: Risk Tools Identifiedmentioning

confidence: 99%

“…A number of papers did include a reference 45,48,[50][51][52][53][54][55] to resources where details of the development and validation of the respective risk tools could be found. No technical performance details or references were included in three papers.…”

Section: Risk Tools Identifiedmentioning

confidence: 99%

“…[44][45][46][47][48]52,54,55 Two studies featured the use of telemedicine 46,50 as part of an overall package of care. A range of primary care and community staff delivered, or were proposed to deliver, these secondary interventions.…”

Section: Interventionsmentioning

confidence: 99%

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Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Snooks

Bailey-Jones

Burge-Jones

et al. 2018

Health Serv Deliv Res

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Background With a higher proportion of older people in the UK population, new approaches are needed to reduce emergency hospital admissions, thereby shifting care delivery out of hospital when possible and safe. Study aim To evaluate the introduction of predictive risk stratification in primary care. Objectives To (1) measure the effects on service usage, particularly emergency admissions to hospital; (2) assess the effects of the Predictive RIsk Stratification Model (PRISM) on quality of life and satisfaction; (3) assess the technical performance of PRISM; (4) estimate the costs of PRISM implementation and its effects; and (5) describe the processes of change associated with PRISM. Design Randomised stepped-wedge trial with economic and qualitative components. Setting Abertawe Bro Morgannwg University Health Board, south Wales. Participants Patients registered with 32 participating general practices. Intervention PRISM software, which stratifies patients into four (emergency admission) risk groups; practice-based training; and clinical support. Main outcome measures Primary outcome – emergency hospital admissions. Secondary outcomes – emergency department (ED) and outpatient attendances, general practitioner (GP) activity, time in hospital, quality of life, satisfaction and costs. Data sources Routine anonymised linked health service use data, self-completed questionnaires and staff focus groups and interviews. Results Across 230,099 participants, PRISM implementation led to increased emergency admissions to hospital [ΔL = 0.011, 95% confidence interval (CI) 0.010 to 0.013], ED attendances (ΔL = 0.030, 95% CI 0.028 to 0.032), GP event-days (ΔL = 0.011, 95% CI 0.007 to 0.014), outpatient visits (ΔL = 0.055, 95% CI 0.051 to 0.058) and time spent in hospital (ΔL = 0.029, 95% CI 0.026 to 0.031). Quality-of-life scores related to mental health were similar between phases (Δ = –0.720, 95% CI –1.469 to 0.030); physical health scores improved in the intervention phase (Δ = 1.465, 95% CI 0.774 to 2.157); and satisfaction levels were lower (Δ = –0.074, 95% CI – 0.133 to –0.015). PRISM implementation cost £0.12 per patient per year and costs of health-care use per patient were higher in the intervention phase (Δ = £76, 95% CI £46 to £106). There was no evidence of any significant difference in deaths between phases (9.58 per 1000 patients per year in the control phase and 9.25 per 1000 patients per year in the intervention phase). PRISM showed good general technical performance, comparable with existing risk prediction tools (c-statistic of 0.749). Qualitative data showed low use by GPs and practice staff, although they all reported using PRISM to generate lists of patients to target for prioritised care to meet Quality and Outcomes Framework (QOF) targets. Limitations In Wales during the study period, QOF targets were introduced into general practice to encourage targeting care to those at highest risk of emergency admission to hospital. Within this dynamic context, we therefore evaluated the combined effects of PRISM and this contemporaneous policy initiative. Conclusions Introduction of PRISM increased emergency episodes, hospitalisation and costs across, and within, risk levels without clear evidence of benefits to patients. Future research (1) Evaluation of targeting of different services to different levels of risk; (2) investigation of effects on vulnerable populations and health inequalities; (3) secondary analysis of the Predictive Risk Stratification: A Trial in Chronic Conditions Management data set by health condition type; and (4) acceptability of predictive risk stratification to patients and practitioners. Trial and study registration Current Controlled Trials ISRCTN55538212 and PROSPERO CRD42015016874. Funding The National Institute for Health Research Health Services Delivery and Research programme.

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Section: Settingsmentioning

confidence: 99%

“…46 Three wholly qualitative studies were included, 27,53,54 with qualitative methods also featuring in two others.…”

Section: Study Designsmentioning

confidence: 99%

Section: Risk Tools Identifiedmentioning

confidence: 99%

Section: Risk Tools Identifiedmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

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Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Snooks

Bailey-Jones

Burge-Jones

et al. 2018

Health Serv Deliv Res

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Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

Lusignan

Chan

Arreal

et al. 2013

Behaviour Research and Therapy

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BackgroundReferral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known.MethodRoutinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence.ResultsOverall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference −0.21, p = 0.003).ConclusionsReferral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance.

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Gestión de casos y cronicidad compleja: conceptos, modelos, evidencias e incertidumbres

Morales-Asencio

2014

Enfermería Clínica

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Variability in selecting patients to manage in the community: a service evaluation of community matron's case-finding strategies

Abstract: Inter-professional networks, personal experience and training influence the patients identified for case management. The combination of an improved case finding tool and a better defined role for community matrons could lead to more standardized and equitable case selection.

Cited by 4 publications

References 12 publications

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

Gestión de casos y cronicidad compleja: conceptos, modelos, evidencias e incertidumbres

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