The current CRY screening protocol requires a specialist doctor to conduct the medical consultation with each person being tested in order to evaluate their health (symptom) questionnaire. Whilst this is currently an important role there is a significant cost implication.
Furthermore, automation of the consultation has the potential to not just replace the medical consultation but it also has the potential to improve the way young people are screened. The way doctors conduct consultations and investigations into symptoms are inevitably variable, dependent on a number of factors, and the automated consultation would objectively evaluate each of the symptoms.
In order to address this issue, a novel approach to screening was recently undertaken and published by a Canadian research group in 2016. They devised a screening protocol with a revised health questionnaire (SCBC) and eliminated the physical examination and on-site physician. They compared this screening protocol with the standard method of screening in Canada which is similar to that adopted by CRY. Their results suggested that the new SCBC questionnaire (automated consultation) was able to identify the people requiring referral as well as the medical consultation.
The research team at CRY aims to evaluate the SCBC (automated consultation) for use within the CRY screening programme. The aim is to devise an automated evaluation of individual symptoms which has the same sensitivity or specificity as the health consultation to replace the medical consultation. This would enable CRY to significantly increase the number of people tested each year. A specialist doctor would still be required to evaluate the ECGs and process all medical referral letters. However, it is anticipated the doctor could evaluate 3-4 times more ECGs if there are not also required to conduct medical consultations.
The first phase of the study will be to pilot an evaluation of the SCBC questionnaire on 3,000 screened individuals to evaluate if the 2016 Canadian findings can be replicated. If the initial evaluation of the SCBC questionnaire provides equal or improved sensitivity and specificity as the medical consultation then the study will be repeated on a larger sample of screened individuals (N > 10,000) with the aim of further replicating the findings.
At the point that the automated model of symptom evaluation is validated CRY will implement this model within the CRY screening programme.
This project has the potential to significantly improve the cost-effectiveness of the nationwide screening programme adopted by CRY. This will result in an increased number of young people being screened by CRY with more young sudden cardiac deaths being prevented.
The initial impact evaluation estimates CRY would be able to triple the number of people tested by each doctor. Each CRY doctor currently reviews 3,000 people per annum. This number would increase to 9,000 per annum once the online questionnaire is adopted. This would increase the total number of people CRY can screen from 30,000 to 90,000 each year.
If the 2016 findings are not replicated then CRY will identify the specific variables that reduced the sensitivity and specificity of the measure and revise the online questionnaire to address these issues. From this analysis a new questionnaire will be devised and further evaluated before implementation.
This project has the potential to transform the international protocol for cardiac screening in young people.
Cost – £58,000
Research Fellow – Dr Hamish MacLachlan
Start Date: April 2019
End Date: April 2020
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