title: It could be a 'Golden Goose': a qualitative study of views in primary care on an emergency admission risk prediction tool prior to implementation.
abstract: BACKGROUND
  Rising demand for health care has prompted interest in new technologies to support a shift of care from hospital to community and primary care, which may require clinicians to undertake new working practices. A predictive risk stratification tool (Prism) was developed for use in primary care to estimate patients' risk of an emergency hospital admission. As part of an evaluation of Prism, we aimed to understand what might be needed to bring Prism into effective use by exploring clinicians and practice managers' attitudes and expectations about using it. We were informed by Normalisation Process Theory (NPT) which examines the work needed to bring an innovation into use.
  
  
  METHODS
  We conducted 4 focus groups and 10 interviews with a total of 43 primary care doctors and colleagues from 32 general practices. All were recorded and transcribed. Analysis focussed in particular on the construct of 'coherence' within NPT, which examines how people understand an innovation and its purpose.
  
  
  RESULTS
  Respondents were in agreement that Prism was a technological formalisation of existing practice, and that it would function as a support to clinical judgment, rather than replacing it. There was broad consensus about the role it might have in delivering new models of care based on active management, but there were doubts about the scope for making a difference to some patients and about whether Prism could identify at-risk patients not already known to the clinical team. Respondents did not expect using the tool to be onerous, but were concerned about the work which might follow in delivering care. Any potential value would not be of the tool in isolation, but would depend on the availability of support services.
  
  
  CONCLUSIONS
  Policy imperatives and the pressure of rising demand meant respondents were open to trying out Prism, despite underlying uncertainty about what difference it could make.
  
  
  BACKGROUND
  Controlled Clinical Trials no. ISRCTN55538212 .
authors.affiliation: Swansea University Medical School, ILS2, Swansea, SA2 8PP, UK. a.m.porter@swansea.ac.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Porter
authors.affiliation: Swansea University Medical School, ILS2, Swansea, SA2 8PP, UK. m.r.kingston@swansea.ac.uk.
authors.forename: Mark Rhys
authors.initials: MR
authors.lastname: Kingston
authors.affiliation: Swansea University Medical School, ILS2, Swansea, SA2 8PP, UK. b.a.evans@swansea.ac.uk.
authors.forename: Bridie Angela
authors.initials: BA
authors.lastname: Evans
authors.affiliation: Swansea University Medical School, ILS2, Swansea, SA2 8PP, UK. h.a.hutchings@swansea.ac.uk.
authors.forename: Hayley
authors.initials: H
authors.lastname: Hutchings
authors.affiliation: SUCCESS Service User group, Swansea University Medical School, ILS2, Swansea, SA2 8PP, UK. shirley1934@hotmail.co.uk.
authors.forename: Shirley
authors.initials: S
authors.lastname: Whitman
authors.affiliation: Swansea University Medical School, ILS2, Swansea, SA2 8PP, UK. h.a.snooks@swansea.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
mesh_terms: D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D004630:Emergencies; D005260:Female; D017144:Focus Groups; D006760:Hospitalization; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care; D011320:Primary Health Care; D036301:Qualitative Research; D018570:Risk Assessment