IMPROVING THE QUALITY OF MUSCULOSKELETAL CARE THROUGH A CLINICAL DECISION SUPPORT SYSTEM: MIXED-METHODS EVALUATION OF CROSSCOVER IN UK PRIMARY CARE
Jonathan C Hill, H Birkinshaw, M Usman, T Millward, J Bailey, S Wathall, R Naylor, R Malcolm, M Pegg, H Holmes, K Lee, T Wright, A Chudyk, A Braybrooke, R Burgess, M LewisConflict of interest: No conflicts of interest
Source of funding: SBRI and the NHS Greener Team
Purpose
Musculoskeletal (MSK) conditions account for one-in-seven general practice consultations, with low back pain the most common condition. Despite national guidelines, sub-optimal management remains common. Digital clinical decision support systems (CDSSs) may help clinicians deliver guideline-concordant care, but robust evaluations are limited. This study evaluated the effectiveness, safety and implementation of a CDSS (CrossCover) designed to support UK general practice consultations.
Methods
We conducted a mixed-methods, cluster-randomised controlled trial in 19 UK general practices (February–July 2024). Practices were randomised 1:1 and stratified by list size. Clinicians in intervention practices received training and access to the CrossCover CDSS for three months. Electronic health records were analysed to identify adult MSK consultations.
The primary outcome was the proportion of consultations involving one of 12 predefined sub-optimal management options, assessed through blinded review of 120 consultations (60 intervention, 60 control). Secondary outcomes included treatment patterns, clinician engagement, safety reporting and clinician experiences.
Results
Sub-optimal care occurred in 3.3% (2/60) of intervention versus 25% (15/60) of control consultations (adjusted OR 12.30, 95% CI 2.52–59.9; p=0.002). Among 10,182 eligible consultations included, CDSS use was 8.6% (365 cases). Use was associated with increased self-management advice and community referrals, and reduced prescribing and fit-note use. Safety concerns were logged in 6.6% of uses, with no high-risk issues identified. Environmental modelling estimated an 18% reduction in carbon emissions and ~10% annual cost savings if scaled.
Conclusion
The CDSS significantly reduced sub-optimal primary care. Uptake was limited, highlighting the need for improved digital integration and implementation support.