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ABSTRACT: Objective
To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.Design
Cluster trial randomised by paramedic; modelling.Setting
13 ambulance stations in two UK emergency ambulance services.Participants
42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.Interventions
Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture.Main outcome measures
Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.Safety
Further emergency contacts or death within one month.Cost-effectiveness
Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.Results
17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS -0.74, 95% CI -2.83 to +1.28; PCS -0.13, 95% CI -1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without.Conclusions
Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.Trial registration
ISRCTN Register ISRCTN10538608.
SUBMITTER: Snooks HA
PROVIDER: S-EPMC4162545 | biostudies-literature | 2014
REPOSITORIES: biostudies-literature
Snooks Helen Anne HA Carter Ben B Dale Jeremy J Foster Theresa T Humphreys Ioan I Logan Philippa Anne PA Lyons Ronan Anthony RA Mason Suzanne Margaret SM Phillips Ceri James CJ Sanchez Antonio A Wani Mushtaq M Watkins Alan A Wells Bridget Elizabeth BE Whitfield Richard R Russell Ian Trevor IT
PloS one 20140912 9
<h4>Objective</h4>To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.<h4>Design</h4>Cluster trial randomised by paramedic; modelling.<h4>Setting</h4>13 ambulance stations in two UK emergency ambulance services.<h4>Participants</h4>42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.<h4>Interventions</h4>Intervention paramedics received CCDS on Tablet computers to g ...[more]