Related Experiment Video

Updated: May 4, 2026

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack

Published on: May 15, 2020

Predictive risk stratification model: a progressive cluster-randomised trial in chronic conditions management

Hayley A Hutchings, Bridie A Evans, Deborah Fitzsimmons

|December 17, 2013

Insights

This study evaluates Prism, a tool predicting emergency hospital admissions for general practice. It assesses Prism

Area of Science:

Health Services Research
Predictive Analytics in Healthcare
General Practice Innovation

Background:

An aging population increases demand on health and social care services.
New approaches are needed to shift care from hospital to community and general practice settings.
A predictive risk stratification tool (Prism) has been developed to estimate emergency hospital admission risk in general practice.

Purpose of the Study:

To evaluate the effectiveness, cost-effectiveness, and implementation of the Prism tool in general practice.
To assess Prism's impact on patient outcomes, care processes, and practitioner/policymaker perceptions.
To identify barriers and facilitators to Prism implementation in primary care settings.

Main Methods:

A mixed-methods progressive cluster-randomised trial comparing usual care with Prism implementation.
Data collection includes routine data, postal questionnaires (at baseline, 6, 18 months), focus groups, and interviews.
Economic evaluation includes cost-effectiveness and cost-consequence analyses; data analysis uses generalized linear models and survival analysis.

Main Results:

Technical performance will be assessed by comparing predicted vs. actual emergency admissions.
Patient outcomes, costs, satisfaction, and quality of life will be compared between groups.
Qualitative data will explore perceptions and adoption of Prism by practitioners and policymakers.

Conclusions:

The study will provide crucial information on the costs and effects of the Prism tool.
Findings will illuminate practical use, implementation challenges, and perceived value in managing chronic conditions.
Results will inform the integration of predictive tools into primary care for improved patient management.

Read full analysis

Abstract

Background:

An ageing population increases demand on health and social care. New approaches are needed to shift care from hospital to community and general practice. A predictive risk stratification tool (Prism) has been developed for general practice that estimates risk of an emergency hospital admission in the following year. We present a protocol for the evaluation of Prism.

Methods/Design:

We will undertake a mixed methods progressive cluster-randomised trial. Practices begin as controls, delivering usual care without Prism. Practices will receive Prism and training randomly, and thereafter be able to use Prism with clinical and technical support. We will compare costs, processes of care, satisfaction and patient outcomes at baseline, 6 and 18 months, using routine data and postal questionnaires. We will assess technical performance by comparing predicted against actual emergency admissions. Focus groups and interviews will be undertaken to understand how Prism is perceived and adopted by practitioners and policy makers. We will model data using generalised linear models and survival analysis techniques to determine whether any differences exist between intervention and control groups. We will take account of covariates and explanatory factors. In the economic evaluation we will carry out a cost-effectiveness analysis to examine incremental cost per emergency admission to hospital avoided and will examine costs versus changes in primary and secondary outcomes in a cost-consequence analysis. We will also examine changes in quality of life of patients across the risk spectrum. We will record and transcribe focus groups and interviews and analyse them thematically. We have received full ethical and R and D approvals for the study and Information Governance Review Panel (IGRP) permission for the use of routine data. We will comply with the CONSORT guidelines and will disseminate the findings at national and international conferences and in peer-reviewed journals.

Discussion:

The proposed study will provide information on costs and effects of Prism; how it is used in practice, barriers and facilitators to its implementation; and its perceived value in supporting the management of patients with and at risk of developing chronic conditions.

Trial Registration:

Controlled Clinical Trials ISRCTN no. ISRCTN55538212.

More Related Videos

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

Published on: January 12, 2018

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Published on: September 20, 2019

Related Concept Videos

Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches

Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches

Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...

Randomized Experiments

Randomized Experiments

The randomization process involves assigning study participants randomly to experimental or control groups based on their probability of being equally assigned. Randomization is meant to eliminate selection bias and balance known and unknown confounding factors so that the control group is similar to the treatment group as much as possible. A computer program and a random number generator can be used to assign participants to groups in a way that minimizes bias.
Simple randomization
Simple...

Hazard Ratio

Hazard Ratio

The hazard ratio (HR) is a widely used measure in clinical trials to compare the risk of events, such as death or disease recurrence, between two groups over time. It reflects the ratio of hazard rates—the instantaneous risk of the event occurring—between a treatment group and a control group. This measure provides valuable insights into the relative effectiveness of a treatment by assessing how the risk of an event differs between the two groups.
For example, in a clinical trial...

Articles linked to this work by shared authors, journal, and citation graph.

"A better system" - managing the adverse effects of prescribed medicines: Cluster-randomised controlled trial and process evaluation of the ADRe Profile in primary care.

PloS one·2026

Navigating Emergency Care After Injury: A Qualitative Study of Asylum Seekers and Refugees in England and Wales Using the Candidacy Framework (BE SURE Study).

Health expectations : an international journal of public participation in health care and health policy·2026

Effectiveness of Multidisciplinary "Case Management" Approaches to the Management of Patients Who Make High Use of the Emergency Ambulance Service: A Quasi-experimental Evaluation Using Linked Routine Records.

Journal of the American College of Emergency Physicians open·2026

Relationship between participant-reported outcomes, residual beta cell function and metabolic parameters in youth with newly diagnosed type 1 diabetes.

Diabetologia·2026

PICCOS: study protocol for pressurised intraperitoneal aerosolised chemotherapy (PIPAC) in the management of cancers of the colon, ovary and stomach: a randomised controlled, phase II trial of efficacy in peritoneal metastases.

Pleura and peritoneum·2026

Reducing the impact of diabetic foot ulcers (REDUCE): study protocol for an effectiveness and cost-effectiveness randomised controlled trial with embedded process evaluation.

BMJ open·2026

See all related articles