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

Abstract

Introduction 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. Methods 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). Results 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. Conclusion 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.

Assessing patients’ experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot

“…We also aimed to develop a frame of knowledge to facilitate decision-making at policy level and inform future initiatives. Results from the one year pilot, including changes in care processes and health outcomes, are reported elsewhere [23]. Here, we present additional findings resulting from in-depth analyses of patients' responses to provide a detailed and accurate picture of how patients experienced integrated care and enable useful conclusions to be drawn about the impact of integrated care on various aspects of patient experience.…”

Delivering Integrated Care to the Frail Elderly: The Impact on Professionals’ Objective Burden and Job Satisfaction

“…It is widely believed that patient-centred care requires additional coordination activities on top of regular practice routines [8910161718]. Leutz [10] noted that ‘integration costs before it pays’, and many in his wake have noted that the up-front investments of integrated care are unavoidable, whereas the future pay-off is uncertain [29101138]. The transition towards integrated working is also believed to be a long-term process from which no short-term efficiency gains can realistically be expected [26].…”

“…The present study confirms that this is indeed the case, at least in the first 12 months of integrated working. However, given enough time, integrated working may prove beneficial, as it increasingly becomes a practice routine [11121338]. …”

“…Consequently, integrated care may cause staff burnout and retention problems, affecting its sustainability in the long run [7112729]. Several authors have therefore called for better support of practices developing integrated care to offset the detrimental impacts on staff, for instance by providing additional financial and human resources [1318223839404142]. …”

Using information to deliver safer care: a mixed-methods study exploring general practitioners' information needs in North West London primary care

“…This study was conducted in North West London around the time when a new model of integrated care was piloted 17–21. The North West London Integrated Care Pilot involves collaboration and exchange of information between providers from primary and secondary care, along with community, mental health and social services, with the aim to improve continuity of care for people with diabetes and the elderly.…”