Workpackage 2: Decision Support In Primary Care

This work package builds on the work that we completed relating to Clinical Prediction Rules (CPRs) in primary care. To this end, we will evaluate the impact of implementing CPRs at point-of-care utilising the Electronic Patient Record (EHR). We will integrate the CPR register with ongoing European TRANSFoRm work while continuing observational research into the incidence and aetiology of error in primary care and development of interventions that combat common diagnostic error. To give context, CPRs are clinical tools that quantify the contribution of the history, physical examination and diagnostic tests and stratify patients according to the probability of having a target disorder. The outcome of interest can be diverse and range across the diagnostic, prognostic and therapeutic spectrum. Furthermore, CPRs have been developed, validated and used across the primary, secondary and tertiary care settings. Developing and validating a CPR is a particular form of observational epidemiological research that requires reference to specific methodological standards. Conventionally CPRs go through three distinct stages prior to full implementation in a clinical setting:
1) development of the CPR - establishing the independent and combined effect of explanatory variables that can include symptoms, signs or diagnostic tests;
2) narrow and broad validation- where the explanatory variables or clinical predictors in the derivation CPR set are assessed in separate populations; and lastly
3) impact analysis of the CPR- assessed by means of an RCT where the impact of applying the CPR in a clinical setting is measured either by patient outcome, health professional behaviour, resource use or any combination of these outcomes.

The following is a summary of the proposed work in WP2:

  1. Dissemination and integration of international register of clinical prediction rules

    1.1 Dissemination and update of the international register of Clinical Prediction Rules (CPRs) in primary care
    1.2 Integration of CPR register with European TRANSFoRm collaborators

  2. Implementation of computer based clinical decision support through integration with the Electronic Health Record (EHR)

    2.1 ComputeriseD dECisIon support for poorly-controlleD TypE 2 Diabetes (DECIDE)
    2.2 Rational use of antibiotics in primary care

  3. Diagnostic and therapeutic error: patients and health professional perspectives

    3.1 Patients and health professionals’ perspectives of diagnostic and therapeutic error in primary care
    3.2 Epidemiology of diagnostic and therapeutic error in primary care
    3.3 Design and evaluation of a CDSS intervention to reduce diagnostic and prescribing error in primary care