Evaluation of the costs and benefits of this complex technology will provide valuable information about the development of appropriate care pathways and the potential avoidance of hospital admissions in this vulnerable patient group. Methods/Design Study Aim The aim of this research is to assess the costs and benefits of a complex healthcare intervention for Inhibitors,research,lifescience,medical older people for whom an emergency ambulance call has been made following a fall. The intervention comprises CCDS software and training for paramedics to help them decide whom to take to hospital and whom to leave at home with referral to a community-based falls service. Study Design

and Setting The study is a pragmatic cluster randomised trial with a qualitative component. Allocation will randomise paramedics rather than patients,

Inhibitors,research,lifescience,medical since the intervention targets health professionals with the aim of studying effects on patient outcomes [27]. Intervention The intervention being evaluated is a complex package which comprises paramedic training and CCDS software. The software is installed onto hand-held computers, Inhibitors,research,lifescience,medical forming part of an electronic patient record (EPR). We shall evaluate this package as a whole, in line with the recommendations of the Medical Research Council (MRC) for evaluating complex interventions to improve health [28], as the component parts are interdependent and not easily separated for the purpose of testing. Paramedics randomly Inhibitors,research,lifescience,medical allocated to the intervention group will receive a one-day classroom-based training course. Training will include systematic demonstration of the mechanics and functionality of the software, coupled with practice and supervised role play. selleck compound Critical reflection and discussion will be encouraged throughout the training. Knowledge reviews will ensure competence and understanding of key aspects of the software functionality. Paramedics will then have a period of four weeks to practise using the new technology. Towards the end of this period, we shall audit their use of the CCDS to ensure they have achieved proficiency. The CCDS software is on a hand-held

tablet Inhibitors,research,lifescience,medical Personal Computer (PC), for use by ambulance paramedics attending patients. It will help them to make decisions about the clinical and social care needs of older people who fall. The CCDS software sits alongside the EPR. The CCDS prompts the assessment and examination of injuries associated with the fall, co-morbidity that Carnitine palmitoyltransferase II may have contributed to the fall (e.g. breathlessness or chest pain), psycho-social needs (e.g. cognitive state and ability to undertake activities of daily living) and assessment of environmental risk. Based on these assessments, the CCDS suggests a care plan (e.g. transfer to ED, referral to specific community services and/or patient advice). The clinical assessment component of the CCDS was the intervention in a previous trial with ambulance services [29].