Implementing emergency admission risk prediction in general practice: a qualitative study

Using computer software in general practice to predict patient risk of emergency hospital admission has been widely advocated, despite limited evidence about effects. In a trial evaluating the introduction of a Predictive Risk Stratification Model (PRISM), statistically significant increases in emergency hospital admissions and use of other NHS services were reported without evidence of benefits to patients or the NHS. To explore GPs' and practice managers' experiences of incorporating PRISM into routine practice. Semi-structured interviews were carried out with GPs and practice managers in 18 practices in rural, urban, and suburban areas of south Wales. Interviews (30-90 min) were conducted at 3-6 months after gaining PRISM access, and ∼18 months later. Data were analysed thematically using Normalisation Process Theory. Responders ( = 22) reported that the decision to use PRISM was based mainly on fulfilling Quality and Outcomes Framework incentives. Most applied it to