Performance validation of the PRADA digital care system in a cohort-controlled study demonstrates improved end-of-life registration associated with reduced adverse outcomes

Abstract Rising urgent care use, avoidable hospital deaths, and missed end-of-life (EOL) registration reflect poor care at this critical phase of life. These are known to be avoidable by earlier identification and EOL registration for effective care planning. Current identification tools are generally non-digital. PRADA, a digital system, uses prediction methodologies for early identification of individuals, escalated to clinicians in active decision support, to promote clinical assessment, the completion of EOL process, EOL registration and to improve outcomes. Our objective was to assess its effectiveness. In 12 participating general practices, baseline EOL metrics were assessed retrospectively over 2 years (n=64,887, alive 63,344 (97.6%), died 1,543 (2.4%)). Following implementation of the PRADA system outcomes were determined prospectively over 1 -year (n= 66,321 (alive 65,496 (98.7%), died 831 (1.3%)). EOL registration in those that died, versus non-registration, was associated with lower A/E attendances, emergency admissions, hospital bed day occupancy (all p