Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn Register of Clinical Prediction Rules, Methodological Quality Assessment and Implementation Strategies Emma Wallace, Claire Keogh and the HRB Centre for Primary Care Research

2. Outline • Section1 • Development of register of Clinical Prediction Rules (CPRs) • Section 2 • Methodological quality assessment of CPRs • Section 3 - Implementation strategies

3. SECTION 1 Development of Register of Clinical Prediction Rules (CPRs)

4. Definitions • Clinical Prediction Rule • Clinical tool that quantifies the contribution of • Patient History • Physical Examination • Diagnostic Tests • Stratify patients diagnosis • Probability of having target disorder. • Outcome can be in terms of diagnosis, prognosis, referral or treatment

5. CPR Examples1) Ottawa ankle rule

6. 2) The Centor Score

7. 3) CHADS2 Score (i) Congestive heart failure (1 point) (ii) Hypertension (1 point) (iii) Age >75 (1 point) (iv) Diabetes mellitus (1 point) (v)/(vi) History of Stroke /TIA (2 points) CHADS2 Score 1 to 2 CHADS2 Score 0 CHADS2 Score 3 to 6 Moderate risk: 4.0% Low risk: 1.6% High risk: 8.3% Warfarin Anti-platelet treatment or Warfarin Anti-platelet treatment

8. 4) Cardiovascular risk assessment- SCORE chart

9. Stages of development of CPR

10. Aim • Develop a web-based register of CPRs for use in primary care as part of Cochrane Primary Healthcare Field

11. CPR register development • Retrieval of CPRs from MEDLINE difficult; • No indexing term for CPR • Relevance to primary care

12. 30 journals included on the register

13. Methods • Manually searched 30 journals relevant to primary care for the year 2008 (‘reference standard’) • 7 individual electronic searches of the 30 journals • Test accuracy analysis: Sensitivity and specificity • Aim: to maximise sensitivity

14. Results Manual ‘reference standard’ search retrieved 6344 articles, 41 of which were CPRs

15. Creating the International Register: Preliminary findings 2008-1980 resulted in 383 CPRs and 141 Questionnaires relevant to primary care * Preliminary findings

16. Overview of classified CPRs

17. Clinical Domains – ICPC2Percentage articles retrieved for each clinical domain % %

18. SECTION 2 Methodological Quality assessment of CPR register

19. Health Research Reporting

20. Health Research Reporting • International initiative ‘Equator’ set up in 2008 • Aim to provide resources & education enabling improved reporting and monitor progress • Develop network of reporting guidelines e.g. CONSORT- RCTs • No reporting guidelines specific to CPRs to date • McGinn quality assessment tool-internal and external validity

21. Quality assessment of CPR register • Quality assessment of the majority of the CPR register complete • Quality grade of each CPR article included on CPR register

22. SECTION 3 Implementation strategies

23. Bridging the gap: Research to practice Glasziou and Haynes, 2005

24. Implementation 1.Register of CPRs Cochrane Primary Health Care Field 2. Clinical Decision Support Systems (CDSSs)

25. Register of CPRs Cochrane Primary Health Care Field Implement International Register of CPRs that is; Publicly available, web based, user friendly Searchable across clinical domains Maintained and updated

26. Registry 1 2 3 4 5 6

27. Implementation 1.Register of CPRs Cochrane Primary Health Care Field 2. Clinical Decision Support Systems (CDSSs)

28. Clinical Decision Support Systems

29. Clinical Decision Support Systems • Clinical Decision Support Systems (CDSSs) • Systems that are designed to improve clinical decision making Key points • Integrated with the electronic patient record • Available at the point of care • Computerised knowledge base • Provide patient-specific content

30. Completing evidence base/CPR register Register Systematic reviews

31. www.hrbcentreprimarycare.ie

32. Thank you!