TY - JOUR T1 - A systematic review of the probability of repeated admission score in community-dwelling adults JF - J Am Geriatr Soc Y1 - 2013 A1 - Wallace, E A1 - Hinchey, T A1 - Dimitrov, B A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM KW - Aged KW - Aged, 80 and over KW - Brazil KW - Calibration KW - Decision Support Techniques KW - Europe KW - Female KW - Health Care Costs KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Patient Readmission KW - Probability KW - Reproducibility of Results KW - Risk Assessment KW - Sensitivity and Specificity KW - United States KW - Validation Studies as Topic AB - OBJECTIVES: To perform a systematic review of the Probability of Repeated Admission (Pra) score in community-dwelling adults to assess its performance in a range of validation studies in the community setting. DESIGN: Systematic review and meta-analysis. SETTING: Primary and community care. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The primary outcome was hospital admission; secondary outcomes were mortality, hospital days, functional decline, other health service use, and costs. RESULTS: Nine validation studies describing 11 cohorts of individuals aged 65 and older were identified. A metaanalysis of the Pra score in five cohorts (8,843 individuals) with comparable and available data revealed good discrimination performance (summary area under the receiver operating characteristic curve 69.7% (standard error 2.8%)). Pooled specificity was high (96%, 95% confidence interval (CI)=95.8–96.7%), indicating that a Pra score of 0.5 or greater effectively rules in the likelihood of admission, but pooled sensitivity was low (12%, 95% CI=10.5–13.6%). Calibration performance was good, with an overall risk ratio of 1.12 (95% CI=0.89–1.42), indicating that the Pra score reliably predicted hospital admissions. CONCLUSION: The Pra score performs well in predicting hospital admission in community-dwelling adults categorized as high risk according to the score. This tool has clinical and healthcare policy utility in terms of targeting elderly people at highest risk of hospital admission, but the low pooled sensitivity of the score indicates that it is not a reliable way of excluding hospital admission in those stratified as low risk. VL - 61 UR - http://onlinelibrary.wiley.com/doi/10.1111/jgs.12150/abstract IS - 3 ER - TY - JOUR T1 - Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs) JF - BMC Med Inform Decis Mak Y1 - 2011 A1 - Wallace, E A1 - Smith, SM A1 - Perera-Salazar, Rafael A1 - Vaucher, Paul A1 - McCowan, Colin A1 - Collins, Gary A1 - Verbakel, Jan A1 - Lakhanpaul, Monica A1 - Fahey, T KW - Decision Support Techniques KW - Evidence-Based Medicine KW - Humans KW - Physician's Practice Patterns KW - Research Design AB - Clinical Prediction Rules (CPRs) are tools that quantify the contribution of symptoms, clinical signs and available diagnostic tests, and in doing so stratify patients according to the probability of having a target outcome or need for a specified treatment. Most focus on the derivation stage with only a minority progressing to validation and very few undergoing impact analysis. Impact analysis studies remain the most efficient way of assessing whether incorporating CPRs into a decision making process improves patient care. However there is a lack of clear methodology for the design of high quality impact analysis studies.We have developed a sequential four-phased framework based on the literature and the collective experience of our international working group to help researchers identify and overcome the specific challenges in designing and conducting an impact analysis of a CPR.There is a need to shift emphasis from deriving new CPRs to validating and implementing existing CPRs. The proposed framework provides a structured approach to this topical and complex area of research. VL - 11 UR - http://www.biomedcentral.com/1472-6947/11/62 ER - TY - JOUR T1 - Developing an electronic health record (EHR) for methadone treatment recording and decision support JF - BMC Med Inform Decis Mak Y1 - 2011 A1 - Xiao, Liang A1 - Cousins, G A1 - Courtney, Brenda A1 - Hederman, Lucy A1 - Fahey, T A1 - Dimitrov, B KW - Decision Support Techniques KW - Drug Therapy, Computer-Assisted KW - Electronic Health Records KW - Episode of Care KW - Humans KW - Medical Record Linkage KW - Methadone KW - Practice Guidelines as Topic KW - Semantics KW - Systematized Nomenclature of Medicine KW - User-Computer Interface AB - BACKGROUND: In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. METHODS: A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. RESULTS: The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. CONCLUSIONS: The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. VL - 11 UR - http://www.biomedcentral.com/1472-6947/11/5 ER -