E-Thesis 79 views
Policy implementation without evidence: a multi methods study of emergency admission risk stratification in primary care / Mark Kingston
Swansea University Author: Mark Kingston
DOI (Published version): 10.23889/SUthesis.66480
Abstract
Despite an uncertain evidence base, emergency admission risk stratification tools have been widely promoted in the NHS. These tools are underpinned by algorithmic models using routine health data to calculate one year admission risk for all patients in a health community (typically a general practic...
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Swansea, Wales, UK
2024
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | Ph.D |
| Supervisor: | Snooks, Helen ; Porter, Alison ; Hutchings, Hayley |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa66480 |
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| Abstract: |
Despite an uncertain evidence base, emergency admission risk stratification tools have been widely promoted in the NHS. These tools are underpinned by algorithmic models using routine health data to calculate one year admission risk for all patients in a health community (typically a general practice). The tools allow practitioners to identify at-risk individuals to target for preventative care, with the ambition to improve care, and reduce admissions/costs. This study explored why, how and to what extent emergency admission risk stratification tools were introduced in UK primary care, and stakeholder views. I undertook a multi-methods study incorporating systematic literature review; survey of 171 primary care commissioning organisations; follow-on interviews with a sample of commissioners (n=20); a user experience study of tool users (n=29) and a focus group with patients (n=9). The review found that although accuracy of the tools had been addressed, there was little underpinning evidence of effectiveness. Nonetheless, the survey confirmed largescale implementation across the UK; 86.5% of organisations had introduced a tool to general practice. Research evidence had little influence over decisions to implement, but the desire to align with policy recommendations was apparent. Interviews confirmed a complex landscape of tool introduction and use, but often as short-term pilots with few incorporating robust evaluation. I found that implementation challenges were prominent, including a lack of clarity over models of care for identified patients. Most tool users found them acceptable, were willing to use them (often on a trial basis) but reported usability and capacity issues. Patients saw opportunities for admission risk to be communicated in patient/clinician discussions, but I found no evidence that this approach was widespread.I conclude that the promotion and use of the tools was driven by optimism rather than evidence, and there remains a need to better integrate research, policy, and practice. |
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| College: |
Faculty of Medicine, Health and Life Sciences |