OpRESTORE AI-Patient Navigator Study
ConditionVeteran
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorImperial College Healthcare NHS Trust
About this trial
OpRESTORE is a national NHS service that supports UK veterans with complex physical health problems linked to their military service. Veterans referred to OpRESTORE often need care from many different specialists, including surgeons, pain teams, rehabilitation, and mental health services. Currently, decisions about which service is most appropriate are made by a multidisciplinary team (MDT) of clinicians. While effective, this process can be slow, resource-intensive, and sometimes difficult for patients to navigate.
This study will develop and test a new digital "navigator" tool that uses artificial intelligence (AI) to support these referral decisions. The aim is to see whether the tool can safely and accurately match veterans to the right care pathway, while reducing delays and improving patient experience.
The project will be carried out in several stages:
* Reviewing past OpRESTORE records to design the AI model. * Testing the tool alongside the MDT ("shadow testing") to check whether its recommendations match the clinical decisions. * Running a case-control study to compare outcomes between patients referred using AI support and those referred by the MDT alone. * Creating and testing a structured self-referral form to make it easier for veterans to access care directly.
The main outcome will be whether the AI tool makes the same referral decisions as the MDT. Other outcomes include patient satisfaction, quality of life, time taken to reach the right service, and overall costs.
The study will recruit veterans aged 18 or older who are referred to OpRESTORE with a physical health need. It will run for two years. If successful, this approach could free up clinician time, shorten waits for treatment, and improve veterans' health and wellbeing, while laying the foundations for wider use of AI-supported navigation across the NHS.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Meets criteria for referral to OpRESTORE service
Age 18 years or older.
Capacity to consent.
Have a physical health need (e.g. not purely mental health, or seeking social care advice)
Disqualifiers
Referrals processed outside standard MDT workflow.
Patients lacking capacity to consent.
Prisoners.
Acute presentation best managed by emergency services and not appropriate for OpRESTORE.
Trial design
Design model
Parallel
Treatments tested in this trial
AI-OpRESTORE healthcare navigator
Other interventionAn algorithm is developed as part of this study that predicts a patients best treatment pathway based on basic demographic variables, targeted clinical questions and prior clinical records. This is the first version of this algorithm in development built on UK OpRESTORE veteran data and tested on this same population.
OpRESTORE healthcare navigation
Other interventionThis is the current standard of care which is a human healthcare navigation pathway where information is extracted manually, and cases are discussed at the opRESTORE MDT for UK veterans.
Treatment groups
1,389 Participants
are divided into 2 treatment groupsGroup A: Standard care - MDT pathwayActive comparator 1 intervention
Group B: AI-OpRESTORE - automated pathwayExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Algorithm concordance against control
Concordance between algorithm-generated care-pathway recommendations and multidisciplinary team (MDT) decisions. MDT decisions determine the most appropriate treatment pathway and are recorded in the MDT summary document and referral tracking database. Pathways correspond to specific NHS or third-sector services grouped into categories and subcategories (e.g., orthopaedic surgery clinic by joint; ENT services subdivided into ENT clinic or audiology; pain services subdivided into NHS clinics, named consultants, or third-sector programmes). Algorithm outputs are compared with MDT decisions and classified as: full match (category and subcategory), category match only, incorrect recommendation, or referral to MDT due to low algorithm confidence.
Time frame
At completion of both MDT decision and algorithm output generation (whichever occurs later), typically 8 weeks post-referral for prospective cases or after algorithm processing for retrospective data.Secondary outcomes
1
Patient Reported Outcomes (EQ5D-5L)
The increase inpatient reported outcomes (baseline to exit) of patients under the algorithm-supported pathway being equal to or greater than those under standard pathway. The standardised EuroQol EQ5D-5L questionnaire is used. A lower score equates to better quality of life. It is made up of 5 questions and results are presented descriptively as a 5 digit number (with each digit corresponding to each of the questions answers) or as a compound score with a minimum value of 5 and maximum value of 25 (all questions are weighted equally).
Time frame
From recruitment to 6 months post recruitment.2
Referral accuracy
The accuracy of referrals, as determined by independent experts, being equal to or superior to that of the MDT. Results fall into 3 categories similar to the primary outcomes: full match (category and subcategory), category match only, incorrect recommendation. Those referred to the MDT by the algorithm are not considered for this outcome.
Time frame
At the point of outcome decision compared to expert input within 3 months of referral.3
Patient reported experience measures
Patient-reported experience measures (PREMs) assessed post-referral compared between patients using self-referral versus GP referral, and between those running through the algorithm and those running through the manual MDT (4 resulting groups). PREMS is assessed using the Veteran Affairs Trust questionnaire. It is comprised of 4 questions with multiple choice answers on a 5 point Likert scale. Comparison is descriptive across the 4 questions (compound scoring is not validated).
Time frame
From referral to 6 months post referral4
Pathway time efficiency
Time from receipt of referral (self-referral or GP referral) to treatment pathway decision. In the control arm, this is the time from referral receipt to definitive treatment decision recorded at the MDT and documented in the patient tracker and MDT minutes. In the algorithm arm, this is the time from referral receipt to algorithm-generated treatment recommendation. If algorithm confidence is low, the case is referred to the MDT and the time to decision is recorded at completion of the MDT, as in the control arm.
Time frame
From referral receipt to treatment pathway decision (algorithm-generated recommendation or MDT decision), up to 6 months.Other outcomes
1
Suitability for amputees
The suitability of this platform for a subgroup of veteran amputees.
Time frame
Assessed after MDT outcome generated and for a period of 3 months after.Sponsors and contacts
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Source ClinicalTrials.gov
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