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Practice managers key to promoting risk stratification tools, study finds

by Awil Mohamoud
25 September 2020

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Getting the support of practice managers is key to encouraging the use of emergency admission risk stratification (EARS) tools, a study published in the British Journal of General Practice found.

Researchers examined how EARS tools, designed to help predict which primary care patients are at highest risk of admission to hospital within a year, have been adopted and implemented across the UK.

In a survey of 171 UK primary care organisations, including clinical commissioning groups (CCGs) and health boards, respondents ranked practice manager engagement as the most important factor in boosting the use of the tools, followed by clinical leadership, engagement from NHS commissioners and financial incentives. 

Using case studies to highlight the benefits achieved from using the tools in other areas, and the involvement of other NHS organisations, ranked lowest for useful promotion techniques.

The study found that a ‘lack of research evidence’, limited training in using the system and initial commissioning costs were the biggest factors hindering access to or the use of EARS tools in the community, while high staff workloads was also identified. 

The report said: ‘EARS tools are reasonably accurate in terms of predicting which patients are at highest risk of admission to hospital in the following year. UK policy and GP contracts have advocated and incentivised the use of EARS to facilitate the provision of targeted care to those at highest risk, with an assumption that this would reduce emergency admissions. 

‘Recent evidence from a pragmatic randomised trial in general practice has shown that the introduction of EARS was associated with an increase in emergency admissions and the number of days in hospital.’ 

Availability across the UK

The study found that EARS tools are widely available across the UK, with 87% of organisations reporting availability in their area. There are, however, variations by regions, it said.  

Overall, the authors estimated that almost three-quarters of practices in responding areas had access to EARS tools.

The majority of areas with access to the tools reported that GPs and other health professionals were using the system to identify individual patients at risk. 

Many said they were using the tools to inform service planning or development work at the level of commissioners, or ‘practice cluster or networks’, but only a fifth of commissioners reported using EARS for service evaluation.

Just over a third (39%) said the introduction of EARS tools had resulted in new services or the redesign of existing services in the area. 

The study concluded that primary care in the UK has ‘responded to policy and contractual initiatives’ by widely implementing the tools. 

However, the report added that emerging evidence from studies completed after widescale implementation suggest that the use of EARS is ‘costly and ineffective’. 

‘Going forward, policymakers must consider the current evidence base in decision on the future use of emergency admission, and similar risk stratification and case identification tools,’ it said.