Integrated care scheme for older people and people with diabetes has not reduced emergency admissions in its first year

BMJ 2013; 346 doi: (Published 17 May 2013) Cite this as: BMJ 2013;346:f3255
  1. Gareth Iacobucci
  1. 1BMJ

An evaluation of the first year of a major integrated care pilot—seen as a test bed for national government policy—has found little change in emergency admissions and in the wider use of health and care services.

But researchers from the Nuffield Trust and Imperial College London1 said that more time was required to assess the longer term effect of the integrated care pilot in inner northwest London, which has focussed on producing individual care plans for people with diabetes and those older than 75.

The report follows the launch of the government’s new flagship policy to fully integrate health and social care in England within five years, 2 and its results will be keenly monitored by commissioners and policy makers looking to implement new projects across England.

The evaluation said that the pilot found “good progress in designing and implementing a complex intervention,” but the first group of 1236 patients treated under the new case management arrangements had not shown “any significant reduction in emergency admissions or significant changes in the wider use of services.”

It said that cases would need to be followed for longer to assess whether the pilots were affecting emergency hospital admissions and total costs.

The pilot uses a new information technology (IT) tool that allows patients to be stratified according to risk; shares plans across different care settings; identifies those needing intensive case management; and enables the implementation of plans to be monitored—using data from general practices, acute trusts, mental and community healthcare providers, and social care.3

Regular multidisciplinary meetings review and plan people’s care, aided by a newly formed integrated management board of staff, patient representatives and providers, and project management and support from a dedicated team.

Researchers reported a “high level of commitment” to the pilot among healthcare professionals, in particular to the care planning process, which they said had led to “improved collaboration across different parts of the local health and social care system.”

The report said that the pilot area had demonstrated “considerable progress in formalising engagement between a range of organisations in a relatively short time.”

But researchers warned that the project would need to ensure that support structures initially provided by NHS London—such as investment in information technology, leadership, co-ordination, and project management—were maintained, or risk losing momentum.

The report also found that many practitioners were dissatisfied with the information technology tool, citing problems such as duplication of data entry, difficulties with interoperability, and functionality.

Judith Smith, director of policy at the Nuffield Trust, said: “The benchmarks set in this first evaluation report provide a sound basis for the pilot to assess its progress against, particularly in relation to activity, cost, and health outcomes.

“International evidence points to the fact that integrated care takes years to develop, and a minimum of three to five years is needed for such initiatives to show impact in relation to activity, patient experience, and outcomes.”

Josip Car, e-Health unit director at Imperial College London, added: “The evaluation reveals the achievements and challenges that would be familiar to those who have attempted to bring about large scale transformational change in the NHS in the past.”


Cite this as: BMJ 2013;346:f3255


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