Children and Young People’s Health Partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use

Abstract

IntroductionChildren and young people (CYP) in many high-income settings have poor healthcare outcomes, especially those with long-term conditions (LTCs). Emergency and outpatient hospital service use is increasing unsustainably. To address these problems, the Children and Young People’s Health Partnership (CYPHP) has developed and is evaluating an integrated model of care as part of a health systems strengthening programme across two boroughs of London, UK that are characterised by mixed ethnic populations and varying levels of deprivation. The CYPHP Evelina London model of care comprises proactive case-finding and triage, specialist clinics and transformative education and training for professionals working with CYP. Services are delivered by multidisciplinary health teams with an emphasis on increased coordination across primary, community and hospital settings and integration of physical and mental healthcare that accounts for the CYP’s social context.Methods and analysisThe phased roll out of the CYPHP Evelina London model allows an opportunistic population-based evaluation using a cluster randomised controlled trial design. Seventy general practices across two London boroughs, grouped into 23 clusters, were randomised to provide either the CYPHP model of care (n=11) or enhanced usual care (n=12).The evaluation will measure the impact of the CYPHP Evelina London model of care on child and parent health and well-being, healthcare quality and health service use up to 2 years postimplementation. A population-level evaluation will use routinely collected pseudonymised healthcare data to conduct a service-use analysis for all CYP registered with a participating general practice (n=~90 000) with the rate of non-elective admissions as the primary outcome. We will seek consent from a subset of this population, with specific conditions (target n=2138) to assess the impact on patient-reported outcomes using the Paediatric Quality of Life Inventory (PedsQL) and Warwick-Edinburgh Mental Well-Being Scale (WEBWMS) as, respectively, the child- and parent-related primary outcomes.Ethics and disseminationEthics approval obtained from South West-Cornwall & Plymouth Research Ethics Committee. Results will be submitted for publication in peer-reviewed journals. Findings will be generalisable to community-based models of care, especially in urban settings. Our process evaluation will identify barriers and enablers of implementation and delivery of care salient to the context and condition.Trial registration numberNCT03461848; Pre-results.

The Children and Young People’s Health Partnership Evelina London Model of Care: process evaluation protocol

“…Interviews with service providers and commissioners (eg, implementation processes) and economic analysis on cost of implementing the CYPHP Evelina London Model of Care programme (detailed elsewhere8) [I5]…”

“…There is a lack of comprehensive rigorous evidence about integrated models of care for CYP; the evaluation of the CYPHP Evelina London model of care will help fill this evidence gap by providing information on effectiveness and the process of implementing integrated models of care. This process evaluation aims to complement the cRCT of outcomes,8 to understand how and why the CYPHP Evelina London Model of Care achieved its outcomes and to inform stakeholders about how the CYPHP Evelina Model of Care could be implemented in other settings.…”

“…In brief, the targeted and universal interventions within the CYPHP Model have been designed to target barriers to effective management of physical, mental, and social determinants of health at both the service-provider and patient-level to maximise behaviour change. In our accompanying paper, the hypothesised active components of each individual intervention have been mapped onto the TDF to evidence the proposed mechanisms of action through which the intervention may become effective 8. In addition, the mechanism of action across the whole programme, at the service provider, family, and system level is detailed in figure 1.…”

“…This phased roll-out allowed the application of an opportunistic cRCT design, where for the first stage (approximately 2 years) GP practices are randomised to be offered either the CYPHP model (ie, delivery of targeted and universal services to eligible CYP) or enhanced usual care (ie, delivery of universal services only to eligible CYP). Details of the evaluation design are presented in the accompanying protocol paper 8…”

“Women and children last”—effects of the covid-19 pandemic on reproductive, perinatal, and paediatric health

“…But this health system shock might have resulted in an inadvertent “reverse Titanic ” phenomenon5—for example, preterm and caesarean birth rates might rise,6 paediatric vaccination rates fall,7 and too few face-to-face antenatal visits per pregnancy can increase risks associated with severe hypertension 8. System transformations are under way to optimise paediatric outcomes 910…”