Integrated care pilot in north west London: a mixed methods evaluation

oleh: Natasha Curry, Matthew Harris, Laura Gunn, Yannis Pappas, Ian Blunt, Michael Soljak, Nikolaos Mastellos, Holly Holder, Judith Smith, Azeem Majeed, Agnieszka Ignatowicz, Felix Greaves, Athina Belsi, Nicola Costin-Davis, Jessica D Jones Nielsen, Geva Greenfield, Elizabeth Cecil, Susan Patterson, Josip Car, Martin Bardsley

Format: Article
Diterbitkan: Ubiquity Press 2013-07-01

Deskripsi

<p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB">Introduction:</span></strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB"> This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in North West London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and those over 75 years through: care planning; multidisciplinary case reviews; information sharing; and project management support.  </span></p><p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB"> </span></strong></p><p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB">Methods: </span></strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB">The evaluation team conducted qualitative studies of change at organisational, clinician, and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level data sets and a matched control study). <strong></strong></span></p><p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB"> </span></strong></p><p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB">Results:</span></strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB"> The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes.<strong></strong></span></p><p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB"> </span></strong></p><p style="margin: 0cm; margin-bottom: .0001pt; line-height: 200%;"><strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB">Conclusion:</span></strong><span style="line-height: 200%; font-size: 12pt;" lang="EN-GB"> Although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. It is critical that NHS managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.<strong></strong></span></p>