Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs)

Abstract

Clinical Prediction Rules (CPRs) are tools that quantify the contribution of symptoms, clinical signs and available diagnostic tests, and in doing so stratify patients according to the probability of having a target outcome or need for a specified treatment. Most focus on the derivation stage with only a minority progressing to validation and very few undergoing impact analysis. Impact analysis studies remain the most efficient way of assessing whether incorporating CPRs into a decision making process improves patient care. However there is a lack of clear methodology for the design of high quality impact analysis studies.We have developed a sequential four-phased framework based on the literature and the collective experience of our international working group to help researchers identify and overcome the specific challenges in designing and conducting an impact analysis of a CPR.There is a need to shift emphasis from deriving new CPRs to validating and implementing existing CPRs. The proposed framework provides a structured approach to this topical and complex area of research.

Figure 1

Alternative formats and functions of Clinical Prediction Rules (CPRs). Assistive CPR; Wells CPR for Deep Venous Thrombosis (DVT)

Figure 2

Alternative formats and functions of Clinical Prediction Rules (CPRs). Directive CPR; Centor score for sore throat

Figure 3

Theoretical framework for study designs from theory to implementation of CPRs.

Figure 4

Phases for impact analysis of CPRs.