Does the integration of response services lead to meaningful change in healthcare activity? A Case Study Evaluation

TY - JOUR

T1 - Does the integration of response services lead to meaningful change in healthcare activity? A Case Study Evaluation

AU - Hinde, Sebastian

AU - Setters, Jo

AU - Bojke, Laura

AU - Hex, Nick

AU - Richardson, Gerald Anthony

N1 - © 2019 Emerald Publishing Limited. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

PY - 2019/6/20

Y1 - 2019/6/20

N2 - Purpose: The aim of the NHS England Vanguards of new care models was to improve healthcare provision and integration through the coordination of services, seeking to deliver the Five Year Forward View. The purpose of this paper is to report on an extensive analysis of one of the Vanguard programmes, exploring whether the implemented integrated response service (IRS) based in Harrogate, England, resulted in any meaningful change in secondary healthcare activity. Design/methodology/approach: The authors used an interrupted time series framework applied to aggregate secondary care data, specifically emergency attendances for patients 65+, emergency bed days for all adults and non-elective admissions for 65+. Synthetic and geographic comparator data were employed to inform additional scenario analyses. Findings: The majority of the analyses conducted found no statistically significant effect of the IRS team in either direction, suggesting that there was no change in the metrics that could be separated from natural variation. The data correlated with the findings of a qualitative analysis and challenges faced in staffing the team towards the end of the analysis period and the eventual disbanding of the IRS. Research limitations/implications: The analysis was partially hampered by data access challenges, limited to poorly specified aggregate secondary care data, and a poorly specified intervention. Furthermore, the follow-up period was limited by the disbanding of the service. Originality/value: This analysis indicates that the Harrogate-based IRS team is unlikely to have delivered any sustained quantifiable impact on the intended secondary care outcomes. While this does not necessarily demonstrate a failure of the core principle behind the drive for integrated care, it is an important exploration of the challenges of evaluating such a service.

AB - Purpose: The aim of the NHS England Vanguards of new care models was to improve healthcare provision and integration through the coordination of services, seeking to deliver the Five Year Forward View. The purpose of this paper is to report on an extensive analysis of one of the Vanguard programmes, exploring whether the implemented integrated response service (IRS) based in Harrogate, England, resulted in any meaningful change in secondary healthcare activity. Design/methodology/approach: The authors used an interrupted time series framework applied to aggregate secondary care data, specifically emergency attendances for patients 65+, emergency bed days for all adults and non-elective admissions for 65+. Synthetic and geographic comparator data were employed to inform additional scenario analyses. Findings: The majority of the analyses conducted found no statistically significant effect of the IRS team in either direction, suggesting that there was no change in the metrics that could be separated from natural variation. The data correlated with the findings of a qualitative analysis and challenges faced in staffing the team towards the end of the analysis period and the eventual disbanding of the IRS. Research limitations/implications: The analysis was partially hampered by data access challenges, limited to poorly specified aggregate secondary care data, and a poorly specified intervention. Furthermore, the follow-up period was limited by the disbanding of the service. Originality/value: This analysis indicates that the Harrogate-based IRS team is unlikely to have delivered any sustained quantifiable impact on the intended secondary care outcomes. While this does not necessarily demonstrate a failure of the core principle behind the drive for integrated care, it is an important exploration of the challenges of evaluating such a service.

KW - Integrated care

KW - Integrated healthcare

KW - Integration

UR - http://www.scopus.com/inward/record.url?scp=85067868136&partnerID=8YFLogxK

U2 - 10.1108/JICA-03-2019-0009

DO - 10.1108/JICA-03-2019-0009

M3 - Article

SN - 1476-9018

VL - 27

SP - 193

EP - 203

JO - Journal of Integrated Care

JF - Journal of Integrated Care

IS - 3

ER -