Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.

<h4>Objective</h4>To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.<h4>Design</h4>Cluster trial randomised by paramedic; modelling.<h4>Setting</h4>13 ambulance...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Helen Anne Snooks, Ben Carter, Jeremy Dale, Theresa Foster, Ioan Humphreys, Philippa Anne Logan, Ronan Anthony Lyons, Suzanne Margaret Mason, Ceri James Phillips, Antonio Sanchez, Mushtaq Wani, Alan Watkins, Bridget Elizabeth Wells, Richard Whitfield, Ian Trevor Russell
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2014
Materias:
R
Q
Acceso en línea:https://doaj.org/article/18a6e92ae709428785cd80c849c55191
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:18a6e92ae709428785cd80c849c55191
record_format dspace
spelling oai:doaj.org-article:18a6e92ae709428785cd80c849c551912021-11-25T06:00:54ZSupport and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.1932-620310.1371/journal.pone.0106436https://doaj.org/article/18a6e92ae709428785cd80c849c551912014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0106436https://doaj.org/toc/1932-6203<h4>Objective</h4>To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.<h4>Design</h4>Cluster trial randomised by paramedic; modelling.<h4>Setting</h4>13 ambulance stations in two UK emergency ambulance services.<h4>Participants</h4>42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.<h4>Interventions</h4>Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture.<h4>Main outcome measures</h4>Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.<h4>Safety</h4>Further emergency contacts or death within one month.<h4>Cost-effectiveness</h4>Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.<h4>Results</h4>17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS -0.74, 95% CI -2.83 to +1.28; PCS -0.13, 95% CI -1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without.<h4>Conclusions</h4>Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.<h4>Trial registration</h4>ISRCTN Register ISRCTN10538608.Helen Anne SnooksBen CarterJeremy DaleTheresa FosterIoan HumphreysPhilippa Anne LoganRonan Anthony LyonsSuzanne Margaret MasonCeri James PhillipsAntonio SanchezMushtaq WaniAlan WatkinsBridget Elizabeth WellsRichard WhitfieldIan Trevor RussellPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 9, p e106436 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Helen Anne Snooks
Ben Carter
Jeremy Dale
Theresa Foster
Ioan Humphreys
Philippa Anne Logan
Ronan Anthony Lyons
Suzanne Margaret Mason
Ceri James Phillips
Antonio Sanchez
Mushtaq Wani
Alan Watkins
Bridget Elizabeth Wells
Richard Whitfield
Ian Trevor Russell
Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.
description <h4>Objective</h4>To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.<h4>Design</h4>Cluster trial randomised by paramedic; modelling.<h4>Setting</h4>13 ambulance stations in two UK emergency ambulance services.<h4>Participants</h4>42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.<h4>Interventions</h4>Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture.<h4>Main outcome measures</h4>Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.<h4>Safety</h4>Further emergency contacts or death within one month.<h4>Cost-effectiveness</h4>Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.<h4>Results</h4>17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS -0.74, 95% CI -2.83 to +1.28; PCS -0.13, 95% CI -1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without.<h4>Conclusions</h4>Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.<h4>Trial registration</h4>ISRCTN Register ISRCTN10538608.
format article
author Helen Anne Snooks
Ben Carter
Jeremy Dale
Theresa Foster
Ioan Humphreys
Philippa Anne Logan
Ronan Anthony Lyons
Suzanne Margaret Mason
Ceri James Phillips
Antonio Sanchez
Mushtaq Wani
Alan Watkins
Bridget Elizabeth Wells
Richard Whitfield
Ian Trevor Russell
author_facet Helen Anne Snooks
Ben Carter
Jeremy Dale
Theresa Foster
Ioan Humphreys
Philippa Anne Logan
Ronan Anthony Lyons
Suzanne Margaret Mason
Ceri James Phillips
Antonio Sanchez
Mushtaq Wani
Alan Watkins
Bridget Elizabeth Wells
Richard Whitfield
Ian Trevor Russell
author_sort Helen Anne Snooks
title Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.
title_short Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.
title_full Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.
title_fullStr Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.
title_full_unstemmed Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.
title_sort support and assessment for fall emergency referrals (safer 1): cluster randomised trial of computerised clinical decision support for paramedics.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/18a6e92ae709428785cd80c849c55191
work_keys_str_mv AT helenannesnooks supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT bencarter supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT jeremydale supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT theresafoster supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT ioanhumphreys supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT philippaannelogan supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT ronananthonylyons supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT suzannemargaretmason supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT cerijamesphillips supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT antoniosanchez supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT mushtaqwani supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT alanwatkins supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT bridgetelizabethwells supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT richardwhitfield supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
AT iantrevorrussell supportandassessmentforfallemergencyreferralssafer1clusterrandomisedtrialofcomputerisedclinicaldecisionsupportforparamedics
_version_ 1718414264821088256