Title: Development and implementation of new diagnostic processes and technologies in primary care
Funder: Department of Health (England)

Abstract: Aim: To improve diagnostic accuracy and efficiency in NHS primary care by identifying important diagnostic problems, improving the use of existing technologies and developing new technologies. Background: Diagnostic research in primary care is important to the NHS for two reasons: 1) missed diagnoses in primary care cause substantial and unnecessary morbidity, mortality and increase NHS costs; 2) inappropriate use of expensive and unnecessary diagnostic investigations wastes scarce NHS resources. Our own research shows that the diagnostic process in primary care is often haphazard but many of the current problems are fixable. Research plans: Our methodological approach to identifying diagnostic problems and assessing new technologies and diagnostic processes will proceed in 4 stages (A-D): Stage A - Horizon scanning, systematic reviewing, survey work; Stage B - Decision analytic modelling of likely cost-effectiveness; Stage C -Technology development and optimisation; Stage D -Field testing and pilot implementation. The initial work plan will be restricted to 11 studies in which we already have subject specific expertise: childhood infection, hypertensive vascular disease, and cancer. It will be managed by dividing it into 3 workstreams which cut-across the 4 methodological stages A-D described above: 1: Identifying diagnostic problems and potential technological solutions; 2: Developing and field-testing new technologies 3: Developing better clinical decision rules for diagnosis. The workstream 1 studies are: Study 1.1 Cross-sectional study of accuracy of blood pressure measuring devices; Study 1.2 Prospective study of the calibration drift of new blood pressure measuring devices; Study 1.3 Identifying new e-nose technology applications for primary care. The workstream 2 studies are: Study 2.1 Electronic measurement of respiratory rate in children; Study 2.2 Use of salivary test technology to diagnose pertussis infection; Study 2.3 Automatic recording strategy for self monitoring of blood pressure; Study 2.4 Using e-nose to identify Gp A Streptococcus infection in sore throat The workstream 3 studies are: Study 3.1 Can we improve diagnostic triage for sick children? Study 3.2 Can we improve clinical decision making in diagnosis of endometrial cancer? Study 3.3 Can we use e-nose to decide when to give antibiotics for respiratory infection? Study 3.4 Options for undertaking a rapid diagnosis of high blood pressure . As the programme develops new diagnostic technologies will come to notice through horizon scanning and new problems will emerge from current diagnostic practice. NHS organisations (e.g. NICE) will often need a rapid assessment and response.The work plan will therefore need to be flexible with the expectation of taking on new studies opportunistically over time in response to NHS needs and priorities . Research team: The programme brings together four key research groups from the UK with high level expertise in diagnostic technology - Primary Health Care, Engineering Science and Health Economics in Oxford University and Primary Care and General Practice in Birminham University. The two key international collaborators are the Universities of Leuven and Maastricht. Research environment: The Oxfordshire PCT leading this research achieved the top “strong" rating for all its research programmes in 2004/5 and 2005/6. All the UK based University research teams achieved a 5* rating in the last RAE. The international research groups provide complementary international-quality expertise in clinical diagnostics. Anticipated outputs and NHS impact: The most important generic output will be a recognised expert group in the UK able to provide high quality advice to government agencies and be a reference point for horizon scanning, methodological development and technological innovation in relation to primary care diagnostics. The specific outputs anticipated from the initial work-plan are: 1. More effective symptomatic triage of sick children; 2. a fingertip device to measure vital signs; 3. a salivary test to assess persistent cough; 4. less haphazard use of devices to measure blood pressure; 5 more cost-efficient diagnosis of suspected endometrial cancer; 6. if the e-nose proves cost-effective, a substantial reduction in inappropriate antibiotic treatment. Managing A&E workload, reducing stroke and cardiovascular disease, improving cancer referral and reducing inappropriate antibiotic use are all important NHS priorities. Public involvement: Public involvement is particularly important in designing and implementing new diagnostic processes and tests and this will be a component of all studies undertaken.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: GENERIC HEALTH RELEVANCE;CARDIOVASCULAR