CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT
Introduction Safety-netting in primary care is the best practice in cancer diagnosis, ensuring that patients are followed up until symptoms are explained or have resolved. Currently, clinicians use haphazard manual solutions. The ubiquitous use of electronic health records provides an opportunity to...
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BMJ Publishing Group
2020-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/8/e038562.full |
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| author | Clare Bankhead Rafael Perera Simon de Lusignan Ivelina Yonova Susannah Fleming Richard Hobbs Brian D Nicholson Yasemin Hirst Afsana Bhuiya Julian Sherlock |
| author_facet | Clare Bankhead Rafael Perera Simon de Lusignan Ivelina Yonova Susannah Fleming Richard Hobbs Brian D Nicholson Yasemin Hirst Afsana Bhuiya Julian Sherlock |
| author_sort | Clare Bankhead |
| collection | DOAJ |
| description | Introduction Safety-netting in primary care is the best practice in cancer diagnosis, ensuring that patients are followed up until symptoms are explained or have resolved. Currently, clinicians use haphazard manual solutions. The ubiquitous use of electronic health records provides an opportunity to standardise safety-netting practices.A new electronic safety-netting toolkit has been introduced to provide systematic ways to track and follow up patients. We will evaluate the effectiveness of this toolkit, which is embedded in a major primary care clinical system in England:Egerton Medical Information System(EMIS)-Web.Methods and analysis We will conduct a stepped-wedge cluster RCT in 60 general practices within the RCGP Research and Surveillance Centre (RSC) network. Groups of 10 practices will be randomised into the active phase at 2-monthly intervals over 12 months. All practices will be activated for at least 2 months. The primary outcome is the primary care interval measured as days between the first recorded symptom of cancer (within the year prior to diagnosis) and the subsequent referral to secondary care. Other outcomes include referrals rates and rates of direct access cancer investigation.Analysis of the clustered stepped-wedge design will model associations using a fixed effect for intervention condition of the cluster at each time step, a fixed effect for time and other covariates, and then include a random effect for practice and for patient to account for correlation between observations from the same centre and from the same participant.Ethics and dissemination Ethical approval has been obtained from the North West—Greater Manchester West National Health Service Research Ethics Committee (REC Reference 19/NW/0692). Results will be disseminated in peer-reviewed journals and conferences, and sent to participating practices. They will be published on the University of Oxford Nuffield Department of Primary Care and RCGP RSC websites.Trial registration number ISRCTN15913081; Pre-results. |
| format | Article |
| id | doaj-art-804900996ab74f11b5ea7b3457e3694a |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-804900996ab74f11b5ea7b3457e3694a2025-08-20T02:08:39ZengBMJ Publishing GroupBMJ Open2044-60552020-08-0110810.1136/bmjopen-2020-038562CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCTClare Bankhead0Rafael Perera1Simon de Lusignan2Ivelina Yonova3Susannah Fleming4Richard Hobbs5Brian D Nicholson6Yasemin Hirst7Afsana Bhuiya8Julian Sherlock9NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK2Royal College of General Practitioners, London, UK1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK2 University of Oxford Hospitals NHS Foundation Trust, National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKEpidemiology and Public Health, University College London, London, UKNorth Central and East London Cancer Alliance, London, UKNuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UKIntroduction Safety-netting in primary care is the best practice in cancer diagnosis, ensuring that patients are followed up until symptoms are explained or have resolved. Currently, clinicians use haphazard manual solutions. The ubiquitous use of electronic health records provides an opportunity to standardise safety-netting practices.A new electronic safety-netting toolkit has been introduced to provide systematic ways to track and follow up patients. We will evaluate the effectiveness of this toolkit, which is embedded in a major primary care clinical system in England:Egerton Medical Information System(EMIS)-Web.Methods and analysis We will conduct a stepped-wedge cluster RCT in 60 general practices within the RCGP Research and Surveillance Centre (RSC) network. Groups of 10 practices will be randomised into the active phase at 2-monthly intervals over 12 months. All practices will be activated for at least 2 months. The primary outcome is the primary care interval measured as days between the first recorded symptom of cancer (within the year prior to diagnosis) and the subsequent referral to secondary care. Other outcomes include referrals rates and rates of direct access cancer investigation.Analysis of the clustered stepped-wedge design will model associations using a fixed effect for intervention condition of the cluster at each time step, a fixed effect for time and other covariates, and then include a random effect for practice and for patient to account for correlation between observations from the same centre and from the same participant.Ethics and dissemination Ethical approval has been obtained from the North West—Greater Manchester West National Health Service Research Ethics Committee (REC Reference 19/NW/0692). Results will be disseminated in peer-reviewed journals and conferences, and sent to participating practices. They will be published on the University of Oxford Nuffield Department of Primary Care and RCGP RSC websites.Trial registration number ISRCTN15913081; Pre-results.https://bmjopen.bmj.com/content/10/8/e038562.full |
| spellingShingle | Clare Bankhead Rafael Perera Simon de Lusignan Ivelina Yonova Susannah Fleming Richard Hobbs Brian D Nicholson Yasemin Hirst Afsana Bhuiya Julian Sherlock CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT BMJ Open |
| title | CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT |
| title_full | CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT |
| title_fullStr | CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT |
| title_full_unstemmed | CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT |
| title_short | CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT |
| title_sort | casnet2 evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record protocol for a pragmatic stepped wedge rct |
| url | https://bmjopen.bmj.com/content/10/8/e038562.full |
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