1. Division of Population Health Sciences Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs) Emma Wallace, Susan Smith, Raefael Perera-Salazar, Paul Vaucher, Colin McCowan, Gary Collins, Jan Verbakel, Monica Lakhanpaul, Tom Fahey

2. Division of Population Health Sciences Outline Introduction to impact analysis of CPRs International Diagnosis and Prognosis Prediction (IDAPP) group Framework for impact analysis of CPRs Summary

3. Division of Population Health Sciences Introduction

4. Division of Population Health Sciences Introduction Impact analysis represents highest level of evidence Evidence that CPR; -Changes physician behaviour -Improves process of care -Improves patient outcomes -+/- reduces costs

5. Division of Population Health Sciences Impact analysis of CPRs: challenges -Relatively few impact analysis studies -Challenges include: Mode of delivery at the point of care Acceptability to clinicians Applicability of CPR in a new setting

6. Background to framework International Diagnosis and Prognosis Prediction (IDAPP) group recently established Researchers from Ireland, UK, Europe, Canada Inaugural meeting in September 2010, Oxford -Day 1: Oral presentations -Day 2: Break out sessions CPR usability and uptake, Potential collaborations

7. Division of Population Health Sciences

8. Impact analysis of CPRs: framework  Break out session: usability and uptake Development of a sequential four-phased framework Based on MRC framework for complex interventions Address barriers to and challenges of impact analysis at each phase

9. Division of Population Health Sciences Stages of development of CPR

10. Study designs: theory to implementation of CPRs

11. Division of Population Health Sciences Impact analysis of CPRs framework

12. Division of Population Health Sciences Phase 1: Exploratory phase Focuses on suitability of CPR for impact analysis Derived and broadly validated CPR components clinically sensible, comprehensive and fit for purpose CPR finalised by end of Phase 1

13. Division of Population Health Sciences Phase 2: Preparation for impact analysis Assess acceptability of CPR to providers and patients Identify potential barriers: - Feasibility/Setting - Delivery mode - Clinical preparation Pilot intervention

14. Division of Population Health Sciences Phase 3: Experimental phase Measure effectiveness of CPR Appropriate study design Outcomes: patient, process of care, physician behaviour, cost User feedback, Patient satisfaction Lessons from failed impact analysis studies

15. Division of Population Health Sciences Phase 4: Dissemination and long term implementation Translation of CPR from a research setting into everyday clinical practice Consider throughout earlier phases Variability in use of CPR over time Re-evaluation

16. Framework for impact analysis of CPRs

17. Division of Population Health Sciences Summary Framework provides a structured approach to impact analysis Robustly derived and validated CPR Identify barriers early Pilot intervention Consider dissemination throughout earlier phases