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

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: Pr...

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Autores principales: Wallace, Emma, Uijen, Maike J M, Clyne, Barbara, Zarabzadeh, Atieh, Keogh, Claire, Galvin, Rose, Smith, Susan M, Fahey, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800123/
https://www.ncbi.nlm.nih.gov/pubmed/27008685
http://dx.doi.org/10.1136/bmjopen-2015-009957
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author Wallace, Emma
Uijen, Maike J M
Clyne, Barbara
Zarabzadeh, Atieh
Keogh, Claire
Galvin, Rose
Smith, Susan M
Fahey, Tom
author_facet Wallace, Emma
Uijen, Maike J M
Clyne, Barbara
Zarabzadeh, Atieh
Keogh, Claire
Galvin, Rose
Smith, Susan M
Fahey, Tom
author_sort Wallace, Emma
collection PubMed
description 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.
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spelling pubmed-48001232016-03-29 Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review Wallace, Emma Uijen, Maike J M Clyne, Barbara Zarabzadeh, Atieh Keogh, Claire Galvin, Rose Smith, Susan M Fahey, Tom BMJ Open General practice / Family practice 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. BMJ Publishing Group 2016-03-15 /pmc/articles/PMC4800123/ /pubmed/27008685 http://dx.doi.org/10.1136/bmjopen-2015-009957 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle General practice / Family practice
Wallace, Emma
Uijen, Maike J M
Clyne, Barbara
Zarabzadeh, Atieh
Keogh, Claire
Galvin, Rose
Smith, Susan M
Fahey, Tom
Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
title Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
title_full Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
title_fullStr Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
title_full_unstemmed Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
title_short Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
title_sort impact analysis studies of clinical prediction rules relevant to primary care: a systematic review
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800123/
https://www.ncbi.nlm.nih.gov/pubmed/27008685
http://dx.doi.org/10.1136/bmjopen-2015-009957
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