The findings from this study provide preliminary evidence to support the meaningfulness, usefulness, and appropriateness of inferences made from IDUQOL total scores.
Given the importance of diet in reproductive-aged women, the appropriateness of recommendations made in international food selection guides needs to be evaluated and future revisions should consider providing alternative food group recommendations, to accommodate differing dietary patterns.
The criticisms that NHS 111 sends more patients than necessary to A&E departments therefore appears correct, though we were not able in this study to assess the appropriateness of decisions made by either the GPs or the call handlers.
For a study to be categorised as having assessed decision appropriateness, the appropriateness of the decisions made must have been explicitly assessed in reference to some standard, or scenarios must have been designed according to some standard such that the appropriate decision was evident.
Both approaches to the assessment of appropriateness made in this study - based on the view of the caller, or the rule based assessment - rested on the self reported perceptions and actions of callers who responded to the questionnaire.
Another limitation of this study is that we have no data on the appropriateness of the referrals made by each model.
Unfortunately, design limitations, most notably the small sample size and the response rate of only 30.5%, seriously limit the study's primary conclusion that there was no difference in the appropriateness of decision-making between GPs who made recommendations after calculating CHD risk (N = 52) and those who made recommendations without calculating risk (N = 26, P = 0.21).
The correlation between the latent variables of the model (Bartlett test of sphericity = 137.5 with 9 df, p < 0.0001) confirmed, moreover, the appropriateness of the choices made for the multivariate data analysis (it was all further supported by positive results from Pillai's test, Hotelling's T2, Wilks' lambda, all expressing significant values at the level p < 0.000).
We intend to continue to monitor the number and appropriateness of referrals and make adjustments to optimise sensitivity and specificity.
Similar to Hypothesis 1, we used single-day admissions to assess the appropriateness of the decisions made in the ED: Hypothesis 2: There is a negative relationship between viewing EHR IS (including local or external information) and single-day admissions.
