Improving event prediction using general practitioner clinical judgement in a digital risk stratification model: a pilot study

Numerous tools based on electronic health record (EHR) data that predict risk of unscheduled care and mortality exist. These are often criticised due to lack of external validation, potential for low predictive ability and the use of thresholds that can lead to large numbers being escalated for asse...

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Bibliographic Details
Published in:BMC medical informatics and decision making 2024-12, Vol.24 (1), p.382
Main Authors: Parry, Emma, Ahmed, Kamran, Guest, Elizabeth, Klaire, Vijay, Koodaruth, Abdool, Labutale, Prasadika, Matthews, Dawn, Lampitt, Jonathan, Nevill, Alan, Pickavance, Gillian, Sidhu, Mona, Warren, Kate, Singh, Baldev M
Format: Article
Language:English
Subjects:
Adult
Aged
Clinical Reasoning
Electronic Health Records
Female
General Practitioners
Humans
Male
Middle Aged
Pilot Projects
Risk Assessment - methods
United Kingdom
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Summary:Numerous tools based on electronic health record (EHR) data that predict risk of unscheduled care and mortality exist. These are often criticised due to lack of external validation, potential for low predictive ability and the use of thresholds that can lead to large numbers being escalated for assessment that would not have an adverse outcome leading to unsuccessful active case management. Evidence supports the importance of clinical judgement in risk prediction particularly when ruling out disease. The aim of this pilot study was to explore performance analysis of a digitally driven risk stratification model combined with GP clinical judgement to identify patients with escalating urgent care and mortality events. Clinically risk stratified cohort study of 6 GP practices in a deprived, multi-ethnic UK city. Initial digital driven risk stratification into Escalated and Non-escalated groups used 7 risk factors. The Escalated group underwent stratification using GP global clinical judgement (GCJ) into Concern and No concern groupings. 3968 out of 31,392 patients were data stratified into the Escalated group and further categorised into No concern (n = 3450 (10.9%)) or Concern (n = 518 (1.7%)) by GPs. The 30-day combined event rate (unscheduled care or death) per 1,000 was 19.0 in the whole population, 67.8 in the Escalated group and 168.0 in the Concern group (p 
ISSN:1472-6947
1472-6947
DOI:10.1186/s12911-024-02797-5