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

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dc.contributor.author Wallace, Emma
dc.contributor.author Uijen, Maike J M
dc.contributor.author Clyne, Barbara
dc.contributor.author Zarabzadeh, Atieh
dc.contributor.author Keogh, Claire
dc.contributor.author Galvin, Rose
dc.contributor.author Smith, Susan M.
dc.contributor.author Fahey, Tom
dc.date.accessioned 2016-04-01T10:20:09Z
dc.date.available 2016-04-01T10:20:09Z
dc.date.issued 2016
dc.identifier.citation Wallace, E.,Uijen, M. J.,Clyne, B.,Zarabzadeh, A.,Keogh, C.,Galvin, R.,Smith, S. M.,Fahey, T. (2016) 'Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review'. BMJ open, 6 (33). en_US
dc.identifier.uri http://hdl.handle.net/10344/4998
dc.description peer-reviewed en_US
dc.description.abstract OBJECTIVES: Following 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. SETTING: Primary care. PARTICIPANTS: Adults and children. INTERVENTION: Studies that implemented the CPR compared to usual care were included. STUDY DESIGN: Randomised controlled trial (RCT), controlled before-after, and interrupted time series. PRIMARY OUTCOME: Physician behaviour and/or patient outcomes. RESULTS: A 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. CONCLUSIONS: Despite 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.OBJECTIVES: Following 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. SETTING: Primary care. PARTICIPANTS: Adults and children. INTERVENTION: Studies that implemented the CPR compared to usual care were included. STUDY DESIGN: Randomised controlled trial (RCT), controlled before-after, and interrupted time series. PRIMARY OUTCOME: Physician behaviour and/or patient outcomes. RESULTS: A 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. CONCLUSIONS: Despite 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. en_US
dc.language.iso eng en_US
dc.publisher BMJ Publishing Group en_US
dc.relation.ispartofseries BMJ Open;6: e009957
dc.relation.uri http://bmjopen.bmj.com/content/6/3/e009957.full.pdfhttp://bmjopen.bmj.com/content/6/3/e009957.full.pdf
dc.relation.uri http://dx.doi.org/10.1136/bmjopen-2015-009957
dc.subject clinical prediction rule en_US
dc.subject impact analysis en_US
dc.subject risk prediction en_US
dc.title Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.date.updated 2016-04-01T10:14:08Z
dc.description.version PUBLISHED
dc.identifier.doi 10.1136/bmjopen-2015-009957
dc.contributor.sponsor HRB en_US
dc.relation.projectid HRC/2007/1 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 1631980
dc.internal.copyrightchecked Yes
dc.description.status peer-reviewed


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