Wallace Emma, Uijen Maike J M, Clyne Barbara, Zarabzadeh Atieh, Keogh Claire, Galvin Rose, Smith Susan M, Fahey Tom
HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland Medical school, Radboud University, Nijmegen, The Netherlands.
BMJ Open. 2016 Mar 15;6(3):e009957. doi: 10.1136/bmjopen-2015-009957.
Following appropriate validation, clinical prediction rules (CPRs) should undergo impact analysis to evaluate their effect on patient care. The aim of this systematic review is to narratively review and critically appraise CPR impact analysis studies relevant to primary care.
Primary care.
Adults and children.
Studies that implemented the CPR compared to usual care were included.
Randomised controlled trial (RCT), controlled before-after, and interrupted time series.
Physician behaviour and/or patient outcomes.
A total of 18 studies, incorporating 14 unique CPRs, were included. The main study design was RCT (n=13). Overall, 10 studies reported an improvement in primary outcome with CPR implementation. Of 6 musculoskeletal studies, 5 were effective in altering targeted physician behaviour in ordering imaging for patients presenting with ankle, knee and neck musculoskeletal injuries. Of 6 cardiovascular studies, 4 implemented cardiovascular risk scores, and 3 reported no impact on physician behaviour outcomes, such as prescribing and referral, or patient outcomes, such as reduction in serum lipid levels. 2 studies examined CPRs in decision-making for patients presenting with chest pain and reduced inappropriate admissions. Of 5 respiratory studies, 2 were effective in reducing antibiotic prescribing for sore throat following CPR implementation. Overall, study methodological quality was often unclear due to incomplete reporting.
Despite increasing interest in developing and validating CPRs relevant to primary care, relatively few have gone through impact analysis. To date, research has focused on a small number of CPRs across few clinical domains only.
经过适当验证后，临床预测规则（CPR）应进行影响分析，以评估其对患者护理的影响。本系统评价的目的是对与初级保健相关的CPR影响分析研究进行叙述性综述和批判性评价。
初级保健。
成人和儿童。
纳入实施CPR并与常规护理进行比较的研究。
随机对照试验（RCT）、前后对照试验和中断时间序列分析。
医生行为和/或患者结局。
共纳入18项研究，涉及14种不同的CPR。主要研究设计为RCT（n = 13）。总体而言，10项研究报告实施CPR后主要结局有所改善。在6项肌肉骨骼研究中，5项有效地改变了针对踝关节、膝关节和颈部肌肉骨骼损伤患者开具影像学检查的目标医生行为。在6项心血管研究中，4项实施了心血管风险评分，3项报告对医生行为结局（如开药和转诊）或患者结局（如血脂水平降低）没有影响。2项研究在胸痛患者决策中检验了CPR并减少了不适当的住院治疗。在5项呼吸研究中，2项在实施CPR后有效地减少了咽痛患者的抗生素处方。总体而言，由于报告不完整，研究方法学质量往往不明确。
尽管对开发和验证与初级保健相关的CPR的兴趣日益增加，但进行影响分析的相对较少。迄今为止，研究仅集中在少数临床领域的少数CPR上。
