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. 2013 Jul 25:13:e027.
doi: 10.5334/ijic.1149. eCollection 2013.

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

Natasha Curry  1 , Matthew Harris, Laura H 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
Affiliations

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

Natasha Curry et al. Int J Integr Care. .

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.

Keywords: evaluation studies; health care; health services research; integrated health care systems; patient-centred care; reform.

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Figures

Figure 1.
Figure 1.
Structure of the north-west London integrated care pilot. Note: GPs, General Practitioners.
Figure 2.
Figure 2.
Comparison of patterns of average monthly service use over time for intervention (‘case’) group and their matched controls in inpatient, outpatient and accident and emergency settings.
Figure 3.
Figure 3.
Percentage with good (≤59 mmol/l) HbA1c control by month, three-month rolling average between 2009 and 2012.
Figure 4.
Figure 4.
Trends in new cases of practice registered of dementia and care plans for dementia in the integrated care pilot's practices 2006–2012.
See this image and copyright information in PMC

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