title: Predictive risk stratification model: a progressive cluster-randomised trial in chronic conditions management (PRISMATIC) research protocol.
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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Controlled Clinical Trials ISRCTN no. ISRCTN55538212.
authors: Hayley A
authors: HA
authors: Hutchings
authors: Bridie A
authors: BA
authors: Evans
authors: Deborah
authors: D
authors: Fitzsimmons
authors: Jane
authors: J
authors: Harrison
authors: Martin
authors: M
authors: Heaven
authors: Peter
authors: P
authors: Huxley
authors: Mark-Rhys
authors: MR
authors: Kingston
authors: Leo
authors: L
authors: Lewis
authors: Ceri
authors: C
authors: Phillips
authors: Alison
authors: A
authors: Porter
authors: Ian T
authors: IT
authors: Russell
authors: Bernadette
authors: B
authors: Sewell
authors: Daniel
authors: D
authors: Warm
authors: Alan
authors: A
authors: Watkins
authors: Helen A
authors: HA
authors: Snooks
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D004992:Ethics, Medical; D058006:General Practice; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D012107:Research Design; D012306:Risk; D016019:Survival Analysis