Development of the PriCARE classification for potentially preventable ambulance emergency department visits

ISRCTN ISRCTN22901977
DOI https://doi.org/10.1186/ISRCTN22901977
Submission date
12/09/2020
Registration date
17/09/2020
Last edited
25/01/2023
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Other
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background
Ontario’s emergency departments (EDs) have increasingly become burdened with demand for emergency services exceeding most EDs ability to provide quality and timely care. Despite advancements in administrative, political, health policy, access to primary care, and public awareness initiatives, EDs have continued to remain overutilized with increases to the time of initial physician assessment, care received, discharge, and overall wait time for patients. Additionally, EDs have become congested by patients with non-emergency complaints, when alternative care for their conditions may be more appropriate, would strengthen patient relationships with primary care physicians and are more cost-effective.

Ambulance transport diversion from ED destinations to sub-acute centres does not exist in Ontario, Canada for patients with non-emergency conditions who call for emergency services (911). Conceptually this model of care could improve several healthcare domains such as hospital use, patient navigation, quality of care, or ambulance use. Use of urgent care centres and other sub-acute healthcare units have been shown to decrease the proportion of low acuity (non-emergency) ED cases and provides similar services to EDs but in a limited capacity.

Currently, there is not a gold standard to classify non-emergency patients whose ED visits could be potentially preventable for transport to sub-acute centres. Therefore, an original classification is required to increase the understanding of categorizing ambulance transported patients and to inform future clinical decisions, based on in-hospital outcomes and interventions received. This study aims to develop such a classification.

Who can participate?
Ontario physicians who practice in an emergency department and/or primary care centres.

What does the study involve?
This study will use a RAND/UCLA modified Delphi methodology to survey and assess the consensus of a technical expert committee, composed of Ontario physicians, through a two-phase development and evaluation model. Phase one will determine which ED interventions could be conducted in primary care sub-acute centre destinations and phase two will evaluate the criterion for inclusion in a PriCARE classification that is appropriate as a primary care-like visit and could yield the highest specificity of a same-day discharge ED visit, with no hospital admission or mortality.

What are the possible benefits and risks of participating?
The results of this study will add a new classification to the scientific literature for categorizing patients who are transported to the ED and receive primary care-like visits. This classification will potentially support further research into new models of preventative care as well as ambulance diversion to sub-acute centres. In addition, this study will provide patient-level evidence to inform prospective research to validate the PriCARE classification

No known risks to experts are anticipated as a result of participating in this study. The technical expert committee will be asked to rank secondary data interventions and variations of a classification in a two-phase RAND/UCLA modified Delphi study design. The investigators do not anticipate this being difficult to rate as the experts are practicing physicians.

Where is the study run from?
McMaster University (Canada)

The participating experts of the technical expert committee will be contributing through online means only (questionnaires, video debriefing).

When is the study starting and for how long?
From May 2020 to August 2021

Who is funding the study?
Big Data and Geriatric Models of Care, McMaster University (Canada)

Who is the main contact?
Mr Ryan P Strum
strumr@mcmaster.ca

Contact information

Mr Ryan Strum
Scientific

1280 Main Street West
CLRB 106
Hamilton
L8S 4L8
Canada

ORCiD logoORCID ID 0000-0003-1902-4734
Phone +1 416-898-1160
Email strumr@mcmaster.ca
Dr Andrew Costa
Scientific

1280 Main Street West
CLR-219
Hamilton
L8S 4K1
Canada

Phone +1 (905) 525-9140, ext. 22067
Email acosta@mcmaster.ca

Study information

Study designTwo-phase RAND/UCLA modified Delphi study design
Primary study designOther
Secondary study design
Study setting(s)Internet/virtual
Study typePrevention
Participant information sheet Not available in web format, please use contact details to request a participant information sheet.
Scientific titleDevelopment of the PriCARE classification for potentially preventable ambulance emergency department visits: a RAND/UCLA modified Delphi study protocol
Study acronymPriCARE
Study objectivesA new paramedic-relevant classification for potentially preventable ED visits is valid and reliable and can be used to support new models of preventative care as well as ambulance diversion to sub-acute levels of care.
Ethics approval(s)Granted a waiver exemption 29/07/2020, Hamilton Integrated Research Ethics Board (HiREB; 293 Wellington Street, Suite 102, Hamilton ON, L8L 8E7; +1 905 521 2100; trimks@mcmaster.ca), ref: 2020-11451
Health condition(s) or problem(s) studiedCanadian Classification of Health Interventions conducted in Ontario emergency departments, as reported in the National Ambulatory Care Reporting System database on patients with non-emergent acuities.
InterventionThis study will use a RAND/UCLA modified Delphi methodology to assess the consensus of a technical expert committee through a two-phase development and evaluation model. Phase one will determine which Emergency Department (ED) interventions could be conducted in primary care sub-acute centre destinations and phase two will evaluate the criterion for inclusion in a PriCARE classification that is appropriate as a primary care-like visit and could yield the highest specificity of a same-day discharge ED visit, with no hospital admission or mortality.
Intervention typeOther
Primary outcome measure1. The consensus of the technical expert committee of ED interventions in phase one
2. The consensus of the technical expert committee of a PriCARE classification in phase two
Secondary outcome measures1. Analysis of the PriCARE classification that achieves concordance amongst the technical expert committee, analyzed in the National Ambulatory Care Reporting System ED database from years 2014-2018 for associations of patient-level characteristics with a PriCARE classification, in phase two
Overall study start date01/05/2020
Completion date01/08/2021

Eligibility

Participant type(s)Health professional
Age groupAdult
SexBoth
Target number of participants14-18
Total final enrolment21
Key inclusion criteria1. Experienced physicians with extensive knowledge in emergency medicine or primary care
2. Active healthcare physician who, at the time of the study, is involved in the care of patients in an emergency department and/or primary care centre
Key exclusion criteria1. Non-physician clinicians
2. Physicians not practicing in an emergency or primary care context
3. Physicians not practicing in Canada.
Date of first enrolment15/10/2020
Date of final enrolment15/11/2020

Locations

Countries of recruitment

  • Canada

Study participating centre

McMaster University
1280 Main Street West
Hamilton
L8S 4L8
Canada

Sponsor information

McMaster University
University/education

1280 Main Street West
Hamilton
L8S 4L8
Canada

Phone +1 905-525-9140
Email hrmasst@mcmaster.ca
Website https://healthsci.mcmaster.ca/hei-hrm
ROR logo "ROR" https://ror.org/02fa3aq29

Funders

Funder type

University/education

McMaster University
Government organisation / Universities (academic only)
Alternative name(s)
McMaster, Mac, McMaster Univ., McMaster-Carr
Location
Canada

Results and Publications

Intention to publish date01/10/2021
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryOther
Publication and dissemination planThe study results will be published in a scientific peer-reviewed journal and presented at various conferences.
IPD sharing planThe data collected from the technical expert committee will be analyzed and published as aggregate results; no individual scores will be reported. Each expert participant will be assigned a unique identification (ID) number, and all data will be stored under this ID. No participant level data will be shared with anyone outside of the participant themselves, and all other data from this study will be presented as aggregate. No personal information or patient level data is to be transferred within the study. All participants of this study will have their anonymity maintained by the researchers. All documents will be stored securely and are only assessable by the investigators.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 20/01/2021 22/01/2021 Yes No
Results article 11/01/2022 28/10/2022 Yes No
Results article expert consensus on patient-level characteristics 24/01/2023 25/01/2023 Yes No

Editorial Notes

25/01/2023: Publication reference added.
28/10/2022: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
22/01/2021: Publication reference added.
18/09/2020: Internal review.
17/09/2020: Trial’s existence confirmed by Hamilton Integrated Research Ethics Board.