PDF(Pubmed)
Abstract：
OBJECTIVE: Risk stratification tools that predict healthcare utilisation are extensively integrated into primary care systems worldwide, forming a key component of anticipatory care pathways, where high-risk individuals are targeted by preventative interventions. Existing work broadly focuses on comparing model performance in retrospective cohorts with little attention paid to efficacy in reducing morbidity when deployed in different global contexts. We review the evidence supporting the use of such tools in real-world settings, from retrospective dataset performance to pathway evaluation.
METHODS: A systematic search was undertaken to identify studies reporting the development, validation and deployment of models that predict healthcare utilisation in unselected primary care cohorts, comparable to their current real-world application.
RESULTS: Among 3897 articles screened, 51 studies were identified evaluating 28 risk prediction models. Half underwent external validation yet only two were validated internationally. No association between validation context and model discrimination was observed. The majority of real-world evaluation studies reported no change, or indeed significant increases, in healthcare utilisation within targeted groups, with only one-third of reports demonstrating some benefit.
CONCLUSIONS: While model discrimination appears satisfactorily robust to application context there is little evidence to suggest that accurate identification of high-risk individuals can be reliably translated to improvements in service delivery or morbidity.
CONCLUSIONS: The evidence does not support further integration of care pathways with costly population-level interventions based on risk prediction in unselected primary care cohorts. There is an urgent need to independently appraise the safety, efficacy and cost-effectiveness of risk prediction systems that are already widely deployed within primary care.
METHODS: A systematic search was undertaken to identify studies reporting the development, validation and deployment of models that predict healthcare utilisation in unselected primary care cohorts, comparable to their current real-world application.
RESULTS: Among 3897 articles screened, 51 studies were identified evaluating 28 risk prediction models. Half underwent external validation yet only two were validated internationally. No association between validation context and model discrimination was observed. The majority of real-world evaluation studies reported no change, or indeed significant increases, in healthcare utilisation within targeted groups, with only one-third of reports demonstrating some benefit.
CONCLUSIONS: While model discrimination appears satisfactorily robust to application context there is little evidence to suggest that accurate identification of high-risk individuals can be reliably translated to improvements in service delivery or morbidity.
CONCLUSIONS: The evidence does not support further integration of care pathways with costly population-level interventions based on risk prediction in unselected primary care cohorts. There is an urgent need to independently appraise the safety, efficacy and cost-effectiveness of risk prediction systems that are already widely deployed within primary care.
摘要：
目标：预测医疗保健利用的风险分层工具被广泛整合到全球的初级保健系统中，形成预期护理路径的关键组成部分，高危人群是预防性干预的目标。现有的工作主要集中在比较回顾性队列中的模型性能，而很少注意在不同的全球环境中部署时降低发病率的功效。我们回顾了支持在现实环境中使用此类工具的证据，从回顾性数据集性能到路径评估。
方法：进行了系统搜索，以确定报告发展的研究，验证和部署预测未选择的初级保健队列中医疗保健利用率的模型，与他们目前的实际应用相当。
结果：在筛选的3897篇文章中，确定了51项研究，评估了28种风险预测模型。一半进行了外部验证，但只有两个进行了国际验证。没有观察到验证上下文和模型辨别之间的关联。大多数真实世界的评估研究报告没有变化，或者确实显著增加，在目标群体内的医疗保健利用方面，只有三分之一的报告显示出一些好处。
结论：虽然模型判别对应用背景表现出令人满意的鲁棒性，但几乎没有证据表明对高风险个体的准确识别可以可靠地转化为服务交付或发病率的改善。
结论：证据不支持在未选择的初级保健队列中，基于风险预测，将护理路径与昂贵的人群水平干预措施进一步整合。迫切需要独立评估安全性，已经在初级保健中广泛部署的风险预测系统的有效性和成本效益。
方法：进行了系统搜索，以确定报告发展的研究，验证和部署预测未选择的初级保健队列中医疗保健利用率的模型，与他们目前的实际应用相当。
结果：在筛选的3897篇文章中，确定了51项研究，评估了28种风险预测模型。一半进行了外部验证，但只有两个进行了国际验证。没有观察到验证上下文和模型辨别之间的关联。大多数真实世界的评估研究报告没有变化，或者确实显著增加，在目标群体内的医疗保健利用方面，只有三分之一的报告显示出一些好处。
结论：虽然模型判别对应用背景表现出令人满意的鲁棒性，但几乎没有证据表明对高风险个体的准确识别可以可靠地转化为服务交付或发病率的改善。
结论：证据不支持在未选择的初级保健队列中，基于风险预测，将护理路径与昂贵的人群水平干预措施进一步整合。迫切需要独立评估安全性，已经在初级保健中广泛部署的风险预测系统的有效性和成本效益。
