Understanding clinical prediction models as 'innovations': a mixed methods study in UK family practice

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Abstract

Background: Well-designed clinical prediction models (CPMs) often out-perform
clinicians at estimating probabilities of clinical outcomes, though their adoption by family physicians is variable. How family physicians interact with CPMs is poorly understood, therefore a better understanding and framing within a context-sensitive theoretical framework may improve CPM development and implementation. The aim of this study was to investigate why family physicians do or do not use CPMs, interpreting these findings within a theoretical framework to provide recommendations for the development and implementation of future CPMs.
Methods: Mixed methods study in North West England that comprised an online survey and focus groups.
Results: 138 respondents completed the survey, which found the main perceived
advantages to using CPMs were that they guided appropriate treatment (weighted rank [r] = 299; maximum r=414 throughout), justified treatment decisions (r = 217), and incorporated a large body of evidence (r = 156). The most commonly reported barriers to using CPMs were lack of time (r = 163), irrelevance to some patients (r = 161), and poor integration with electronic health records (r = 147). Eighteen clinicians participated in two focus groups (i.e. 9 in each), which revealed 13 interdependent themes affecting CPM use under three overarching domains: clinician factors, CPM factors and contextual factors. Themes were interdependent, indicating the tensions family physicians experience in providing evidence-based care for individual patients.
Conclusions: The survey and focus groups showed that CPMs were valued when they supported clinical decision making and were robust. Barriers to their use related to their being time-consuming, difficult to use and not always adding value. Therefore, to be successful, CPMs should offer a relative advantage to current working, be easy to implement, be supported by training, policy and guidelines, and fit within the organisational culture.
Original languageEnglish
JournalBMC Medical Informatics and Decision Making
DOIs
Publication statusPublished - 9 Aug 2016

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