Implementation of the children and young people's health partnership model of paediatric integrated care: a mixed-methods process evaluation

Abstract

Objective: A process evaluation of the Children and Young People's Health Partnership (CYPHP) model of integrated care for the interpretation of trial findings and building evidence on the implementation of integrated care for children.

Design: A mixed-methods process evaluation.

Setting: CYPHP was implemented at scale across two inner-city London boroughs in South London, England, as a pragmatic cluster-randomised controlled trial involving nearly 98 000 children, with a nested process evaluation.

Participants: Linked data were available from 73 000 participants. Qualitative data collection was through 102 interviews (group and 1:1) and observations.

Interventions: Local child health clinics delivered by paediatricians and general practitioners and a nurse-led early intervention service for children with tracer conditions (asthma, eczema and constipation), decision support, a primary care hotline, self-management support and health promotion.

Main outcome measures: Five domains of the RE-AIM implementation framework: Reach, Effectiveness, Adoption, Implementation and Maintenance.

Results: Implementation varied depending on resource availability, competing priorities and natural changes over time. Successful implementation drivers included cohesive interprofessional and partnership collaboration.

Conclusions: Integrated care for children can be implemented at scale, but variability, particularly low reach, may limit measurable impact at the population level. Significant health system strengthening, implementation plasticity and contextual tailoring are crucial for ensuring the efficacy and sustainability of impactful integrated care for children.

Trial registration number: NCT03461848.

Keywords: Child Health; Health services research; Paediatrics; Primary Health Care; Qualitative research.

Figure 1. The logic model underlying the Children and Young People's Health Partnership intervention and implementation, describing the anticipated mechanisms of action at the child and family, service provider, and health system levels