Abstract
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/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. 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 datasets and a matched control study). The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the 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. 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 National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.
Highlights
This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London
Bringing together organisations from primary, secondary, community, mental health and social care sectors, the pilot aims to reduce emergency admissions by providing coordinated, multidisciplinary care to those residents who are aged 75+ and/or living with diabetes
Since substantial changes to adverse outcomes such as emergency admissions for chronic diseases are not expected with such a short period of evaluation, we decided it was most relevant to present a range of care process data to provide a broad baseline assessment of performance among the pilot's practices
Summary
Health care systems in developed countries face similar challenges: increasing numbers of older people, more people living longer with multiple long-term conditions and a need to provide correspondingly complex care against a backdrop of ever-tightening finances. Bringing together organisations from primary, secondary, community, mental health and social care sectors, the pilot aims to reduce emergency admissions by providing coordinated, multidisciplinary care to those residents who are aged 75+ and/or living with diabetes. The north-west London integrated care pilot, originally launched for one year in July 2011 but later extended for a further year, constitutes a large-scale change programme involving two hospitals, two mental health providers, three community health care service providers, five municipal providers of social care, two nongovernmental organisations and (by the end of April 2012) 103 general practitioners. The care plans were designed by clinicians and are intended to bring standardisation and best practice across the pilot These are shared amongst participating provider organisations via a bespoke information technology tool, which displays integrated utilisation data using a data integration platform, and a recent Combined Predictive Model score for hospital admission risk [13]. In the first year of the pilot, the Innovation Fund was approximately £450,000 [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
