Introducing a Primary Care Risk Prediction Tool Did Not Reduce Emergency Admissions

Published on: 28th February 2018

Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall.

The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either.

The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the NHS aiming to improve planning and delivery of care for people in the poorest health.

This study, funded by the NIHR Health Services Delivery and Research Programme, evaluated the tool during implementation of a quality and outcomes framework incentive to encourage identification and better management of high-risk patients. The lack of benefit may be because of poor uptake of the tool, lack of available services to help those at risk or the concentration of efforts on too few high-risk individuals. General practices still seem to have found few alternatives to hospital admission for many patients.

Why was this study needed?

There were over five million emergency hospital admissions in 2012/13 in England, for instance, costing around £12.5 billion. About half of these admissions can be accounted for by only 5% of the population. Identifying these patients and ensuring they receive optimal preventive care may, in theory, improve their health outcomes and save NHS resources.

Risk stratification tools are designed to identify people at high risk of adverse events, such as hospital admission within the next 12 months. The Predictive Risk Stratification Model (PRISM), developed by Informing Healthcare and Health Dialog for NHS Wales, is one of several implemented in the UK. Its introduction coincided with a new payment under the Quality and Outcomes Framework (QOF) for GPs to identify people at high risk of emergency admission.

The intention is to use risk scores to target primary and community-care resources where they are most needed. This research aimed to evaluate the use of the tool alongside an incentive in the quality an outcomes framework to see if patient outcomes improved and track resource use.

Click here to visit the NIHR website to read the full article on the research work led by Professor Helen Snooks, Farr Institute Swansea University.

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