Dr. Lucy Hederman

Translational Research and Patient Safety in Europe. Develop a rapid learning healthcare system by integrating primary care electronic health record systems, research systems, and clinical decision support systems.

Diagnosis and management of vulnerable groups in the community: an evidence-based approach using Information and Communication Technology (ICT) Through the Primary Care Research Centre (HRC), we will conduct a programme of research that examines the quality of care across the primary/secondary care interface in vulnerable patient groups utilizing newly established, internationally funded cohort studies, allied to record-linkage with prescribing and in-patient hospitalisation datasets (elderly and children); exploration of a nationally-established prescribing register (methadone users) and establishment of a cohort of pregnant women who are receiving antenatal care at the State's largest maternity hospital. This initial research, designated as Work Package (WP) #1, will establish standards for the quality of care provided for these vulnerable groups, with a particular emphasis on effective medicine monitoring and development of ICT interventions that enhance patient care across the primary/secondary care interface and facilitate self management for patients and decision support for health professionals with a focus on nurse prescribers and GPs. The second part of this HRC programme, WP #2, will focus on evidence-based diagnosis, establishing a register of clinical prediction rules (CPRs) relevant to primary care and undertaking systematic reviews of common clinical conditions in relation to the diagnostic accuracy of symptoms, signs and diagnostic tests available to GPs. The register and systematic reviews will be disseminated through the Cochrane Primary Health Care Field. As part of WP #2 we will also undertake development and validation studies of CPRs identified as key areas for primary care diagnosis. In tandem with this research, observational studies examining diagnostic and therapeutic error in primary care will be undertaken. Lastly, based on the observational epidemiological research concerning quality of care and medicines management, as well as the CPRs register, WP #3 will be based around the development and evaluation of ICT interventions in the form of computer-based clinical decisions support systems (CDSSs), decision aids and self management programmes. Evaluation will be conducted by means of randomised controlled trials (RCTs) with particular focus on interventions to promote initiation and continuation of breastfeeding and a separate RCT to combat obesity in children. The overarching theme of the proposed HRC is the management of vulnerable groups at the primary/secondary care interface. Initial observational research on nationally funded cohorts in WP #1 will allow us to quantify the challenges and develop ICT interventions, relying on the multi-disciplinary background of the co-applicants and collaborators in the HRC. In addition, through the activities carried out in WP #2, a register of CPRs and systematic reviews of CPRs will be developed to enhance evidence-based diagnosis in primary care. The ultimate aim is to develop, test and implement ICT interventions that improve the management and self management of illnesses in the community. Throughout the programme of research of the HRC, close collaboration will occur with key health service colleagues, ensuring translation of research findings into care for patients. Similarly, the datasets developed and used as part of the programme of research in the HRC, will be used as a resource for research-active health professionals in training programmes, particularly the HRB PhD scholar's programme.

Linking Knowledge to Patient Records