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Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study

Mark Kingston Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo, Christopher Burton, Jeremy Dale, Jan Davies, Alex Dearden, Bridie Evans Orcid Logo, Barbara Gomes, Jenna Jones, Rashmi Kumar, Alison Porter Orcid Logo, Berni Sewell, Emma Wallace Orcid Logo

BJGP Open, Start page: BJGPO.2024.0182

Swansea University Authors: Mark Kingston Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo, Alex Dearden, Bridie Evans Orcid Logo, Barbara Gomes, Jenna Jones, Alison Porter Orcid Logo, Berni Sewell

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DOI (Published version): 10.3399/bjgpo.2024.0182

Abstract

Background: Emergency admissions are costly, increasingly numerous, and associated with adverse patient outcomes. Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients’ ris...

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Published in: BJGP Open
ISSN: 2398-3795
Published: Royal College of General Practitioners 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa67870
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Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients&#x2019; risk of emergency hospital admission and can be used to support targeted approaches to improve care and reduce admissions. However, the impact of EARS is poorly understood and there may be unintended consequences. Aim: To assess effects, mechanisms, costs, and patient and healthcare professionals&#x2019; views related to the introduction of EARS tools in England. Design &amp; setting: Quasi-experimental mixed-methods design using anonymised routine data and qualitative methods. Method: We will apply multiple interrupted time-series analysis to data, aggregated at former clinical commissioning group (CCG) level, to look at changes in emergency admission and other healthcare use following EARS introduction across England. We will investigate GP decision making at practice level using linked general practice and secondary care data to compare case-mix, demographics, indicators of condition severity, and frailty associated with emergency admissions before and after EARS introduction. We will undertake interviews (approximately 48) with GPs and healthcare staff to understand how patient care may have changed. We will conduct focus groups (n = 2) and interviews (approximately 16) with patients to explore how they perceive that communication of individual risk scores might affect their experiences and health-seeking behaviours. Conclusion: Findings will provide policymakers, healthcare professionals, and patients, with a better understanding of the effects, costs, and stakeholder perspectives related to the introduction of EARS tools.</abstract><type>Journal Article</type><journal>BJGP Open</journal><volume>0</volume><journalNumber/><paginationStart>BJGPO.2024.0182</paginationStart><paginationEnd/><publisher>Royal College of General Practitioners</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2398-3795</issnElectronic><keywords>primary health care, health services research, emergency medical services, clinical decision rules</keywords><publishedDay>25</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-02-25</publishedDate><doi>10.3399/bjgpo.2024.0182</doi><url/><notes>Protocol</notes><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This study is funded by the NIHR HS&amp;DR programme, project number 150717. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care. The funding application was supported by infrastructure funding from PRIME Centre Wales http://www.primecentre.wales/.</funders><projectreference/><lastEdited>2025-03-31T16:31:22.2536298</lastEdited><Created>2024-10-01T13:56:33.3847080</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Mark</firstname><surname>Kingston</surname><orcid>0000-0003-2242-4210</orcid><order>1</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>2</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>3</order></author><author><firstname>Christopher</firstname><surname>Burton</surname><order>4</order></author><author><firstname>Jeremy</firstname><surname>Dale</surname><order>5</order></author><author><firstname>Jan</firstname><surname>Davies</surname><order>6</order></author><author><firstname>Alex</firstname><surname>Dearden</surname><order>7</order></author><author><firstname>Bridie</firstname><surname>Evans</surname><orcid>0000-0003-0293-0888</orcid><order>8</order></author><author><firstname>Barbara</firstname><surname>Gomes</surname><order>9</order></author><author><firstname>Jenna</firstname><surname>Jones</surname><orcid/><order>10</order></author><author><firstname>Rashmi</firstname><surname>Kumar</surname><order>11</order></author><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>12</order></author><author><firstname>Berni</firstname><surname>Sewell</surname><order>13</order></author><author><firstname>Emma</firstname><surname>Wallace</surname><orcid>0000-0002-9315-2956</orcid><order>14</order></author></authors><documents><document><filename>67870__33695__12c1e6780dd842dba8a3d891d49af464.pdf</filename><originalFilename>67870.VOR.pdf</originalFilename><uploaded>2025-02-27T14:11:24.9414460</uploaded><type>Output</type><contentLength>944236</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025, The Authors. 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spelling 2025-03-31T16:31:22.2536298 v2 67870 2024-10-01 Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study 3442763d6ff0467963e0792d2b5404fa 0000-0003-2242-4210 Mark Kingston Mark Kingston true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 4386276ca8a14b9b73fbcb9e69ea1527 Alex Dearden Alex Dearden true false 6098eddc58e31ac2f3e070cb839faa6a 0000-0003-0293-0888 Bridie Evans Bridie Evans true false 1a8104f9603508df48d75cf75395c93f Barbara Gomes Barbara Gomes true false e662b6c5aba239a9cd0f115d16df0a82 Jenna Jones Jenna Jones true false fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false f6a4af2cfa4275d2a8ebba292fa14421 Berni Sewell Berni Sewell true false 2024-10-01 MEDS Background: Emergency admissions are costly, increasingly numerous, and associated with adverse patient outcomes. Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients’ risk of emergency hospital admission and can be used to support targeted approaches to improve care and reduce admissions. However, the impact of EARS is poorly understood and there may be unintended consequences. Aim: To assess effects, mechanisms, costs, and patient and healthcare professionals’ views related to the introduction of EARS tools in England. Design & setting: Quasi-experimental mixed-methods design using anonymised routine data and qualitative methods. Method: We will apply multiple interrupted time-series analysis to data, aggregated at former clinical commissioning group (CCG) level, to look at changes in emergency admission and other healthcare use following EARS introduction across England. We will investigate GP decision making at practice level using linked general practice and secondary care data to compare case-mix, demographics, indicators of condition severity, and frailty associated with emergency admissions before and after EARS introduction. We will undertake interviews (approximately 48) with GPs and healthcare staff to understand how patient care may have changed. We will conduct focus groups (n = 2) and interviews (approximately 16) with patients to explore how they perceive that communication of individual risk scores might affect their experiences and health-seeking behaviours. Conclusion: Findings will provide policymakers, healthcare professionals, and patients, with a better understanding of the effects, costs, and stakeholder perspectives related to the introduction of EARS tools. Journal Article BJGP Open 0 BJGPO.2024.0182 Royal College of General Practitioners 2398-3795 primary health care, health services research, emergency medical services, clinical decision rules 25 2 2025 2025-02-25 10.3399/bjgpo.2024.0182 Protocol COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University This study is funded by the NIHR HS&DR programme, project number 150717. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care. The funding application was supported by infrastructure funding from PRIME Centre Wales http://www.primecentre.wales/. 2025-03-31T16:31:22.2536298 2024-10-01T13:56:33.3847080 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Mark Kingston 0000-0003-2242-4210 1 Helen Snooks 0000-0003-0173-8843 2 Alan Watkins 0000-0003-3804-1943 3 Christopher Burton 4 Jeremy Dale 5 Jan Davies 6 Alex Dearden 7 Bridie Evans 0000-0003-0293-0888 8 Barbara Gomes 9 Jenna Jones 10 Rashmi Kumar 11 Alison Porter 0000-0002-3408-7007 12 Berni Sewell 13 Emma Wallace 0000-0002-9315-2956 14 67870__33695__12c1e6780dd842dba8a3d891d49af464.pdf 67870.VOR.pdf 2025-02-27T14:11:24.9414460 Output 944236 application/pdf Version of Record true © 2025, The Authors. This article is Open Access: CC BY license. true eng https://creativecommons.org/licenses/by/4.0/
title Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
spellingShingle Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
Mark Kingston
Helen Snooks
Alan Watkins
Alex Dearden
Bridie Evans
Barbara Gomes
Jenna Jones
Alison Porter
Berni Sewell
title_short Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
title_full Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
title_fullStr Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
title_full_unstemmed Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
title_sort Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study
author_id_str_mv 3442763d6ff0467963e0792d2b5404fa
ab23c5e0111b88427a155a1f495861d9
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6098eddc58e31ac2f3e070cb839faa6a
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author_id_fullname_str_mv 3442763d6ff0467963e0792d2b5404fa_***_Mark Kingston
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
4386276ca8a14b9b73fbcb9e69ea1527_***_Alex Dearden
6098eddc58e31ac2f3e070cb839faa6a_***_Bridie Evans
1a8104f9603508df48d75cf75395c93f_***_Barbara Gomes
e662b6c5aba239a9cd0f115d16df0a82_***_Jenna Jones
fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
f6a4af2cfa4275d2a8ebba292fa14421_***_Berni Sewell
author Mark Kingston
Helen Snooks
Alan Watkins
Alex Dearden
Bridie Evans
Barbara Gomes
Jenna Jones
Alison Porter
Berni Sewell
author2 Mark Kingston
Helen Snooks
Alan Watkins
Christopher Burton
Jeremy Dale
Jan Davies
Alex Dearden
Bridie Evans
Barbara Gomes
Jenna Jones
Rashmi Kumar
Alison Porter
Berni Sewell
Emma Wallace
format Journal article
container_title BJGP Open
container_volume 0
container_start_page BJGPO.2024.0182
publishDate 2025
institution Swansea University
issn 2398-3795
doi_str_mv 10.3399/bjgpo.2024.0182
publisher Royal College of General Practitioners
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Emergency admissions are costly, increasingly numerous, and associated with adverse patient outcomes. Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients’ risk of emergency hospital admission and can be used to support targeted approaches to improve care and reduce admissions. However, the impact of EARS is poorly understood and there may be unintended consequences. Aim: To assess effects, mechanisms, costs, and patient and healthcare professionals’ views related to the introduction of EARS tools in England. Design & setting: Quasi-experimental mixed-methods design using anonymised routine data and qualitative methods. Method: We will apply multiple interrupted time-series analysis to data, aggregated at former clinical commissioning group (CCG) level, to look at changes in emergency admission and other healthcare use following EARS introduction across England. We will investigate GP decision making at practice level using linked general practice and secondary care data to compare case-mix, demographics, indicators of condition severity, and frailty associated with emergency admissions before and after EARS introduction. We will undertake interviews (approximately 48) with GPs and healthcare staff to understand how patient care may have changed. We will conduct focus groups (n = 2) and interviews (approximately 16) with patients to explore how they perceive that communication of individual risk scores might affect their experiences and health-seeking behaviours. Conclusion: Findings will provide policymakers, healthcare professionals, and patients, with a better understanding of the effects, costs, and stakeholder perspectives related to the introduction of EARS tools.
published_date 2025-02-25T09:37:12Z
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score 11.059144

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