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Inner North West London Integrated
Care Pilot – year one evaluation
Holly Holder
Fellow in health policy
Ian Blunt
Senior Research Analyst
8 July 2013
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What is the inner North West
London Integrated Care
Pilot?
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Aims of the pilot
Large-scale programme to improve the coordination of care for
people over 75 years of age and/or adults living with diabetes.
Aims:
• Improve outcomes for patients
• Create access to better, more integrated care outside hospital
• Reduce unnecessary hospital admissions
• Enable effective working of professionals across provider
boundaries
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Setting up the pilot
Started in July 2011
Initial £10m investment from
NHS London
Involved organisations:
• Five local authorities
• Three acute hospitals
• Two community hospitals
• 104 general practices
• Representatives from Age
UK and Diabetes UK
Area covers 550k patients
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At the local level – multi-disciplinary groups
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Our evaluation
Evaluation of the
first year active
Sept 2011 – July
2012
Four strands of
research, in
partnership with
Imperial College
Department of
Primary Care and
Public Health
Strategic
implementation
& context
Patient &
professional
experience
Impacts on
service use
and cost
Impact on
health
outcomes
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Key findings on
Strategic implementation & context
and
Patient & professional experience
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Qualitative data collection
Data collection methods
Number completed
Semi-structured interviews with senior leaders of the pilot &
37
participating organisations and other health policy experts
Focus groups with healthcare professionals and managers
4
Survey of healthcare professionals
51 completed in full (25.5% response
rate)
Survey of service users enrolled in the pilot
405 completed in full (20.25% response
rate)
Observation of IMB meetings and meetings of its committees
30 hours
Observation of MDG meetings (of which ten hours were
20 hours
transcribed, coded and analysed in detail)
Semi-structured interviews with GPs about the influence of the
ICP on diagnosis rates
Seven general practices
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Strategic implementation
What worked well?
• Successful engagement of organisations from across health
and social care, assisted by a clear vision of aims
• Sophisticated governance structures critical for engagement of
organisations
• Financial incentives important for bringing people on board
Challenges
• Balancing local autonomy with overall accountability
• Symbolic financial incentives
• Achieving more direct engagement of service users
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Patient and professional experience
What worked well?
• Health professionals had a high level of commitment to the
pilot, in particular the care planning process
• Care planning and Multi Disciplinary Groups improved
collaboration and levels of professional knowledge
Challenges
• Majority of patients had not experienced any changes
• Care planning IT tool led to dissatisfaction amongst many
practitioners. Over half of professionals felt workloads had
increased
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Impacts on service use and
cost - evaluation using
predictive risk techniques
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Quantitative data collection and three-armed approach
The general population of inner North West London
and the pilot’s target population:
• Observed activity using administrative data sets
• Contrasted to other areas of London and
nationally
A fixed cohort of patients who had received a care
plan compared to individuals with similar population
characteristics:
• Observed changes associated with ‘usual care’
• Matched control group identified by: predictive
risk score for emergency hospital admission,
age, sex, prior hospital utilisation, health
conditions etc
Patients with
care plan by
end 2011
(1,494)
Patients
eligible
for ICP
(35,607)
All patients
in ICP
practices
(502,920)
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Emergency admissions for ‘ICP eligible’ patients
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Emergency admissions (ICP
practices)
Distinct emergency admission patterns by financial year in
the main provider
2500
FY 2010/11
2000
FY 2009/10
1500
1000
500
0
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C and W
Imperial
Other
Analysis at person level
Analysis at practice
level gives insight
into overall patterns
of service use…
… but much more
powerful to take
patients known to
have received a
specific intervention
and generate person
level controls
Months >>>
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14000
12000
10000
8000
6000
4000
2000
Apr-12
Mar-12
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
0
Aug-11
Problem of early
evaluation
Recruitment starts
only after ICP has
established itself
Patients need some
follow-up time
We have 3 month
data lag
Performing analysis
after end of first year
– only 1495 eligible
patients
Number of patients consenting to ICP
Recruitment and statistical power
Date consent given
Total ICP membership
Follow up period
Evaluation cohort
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Summary measures on matching
Matches drawn
from population
of similar PCTs
Controls well
matched in all
categories
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Output indicators for cases and controls
+0.09 (p=0.519)
-18 (p=0.758)
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Final thoughts
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Understanding year one of the iNWL ICP
•ICP is an ambitious programme of transformational change,
being implemented at a time of major reform in the NHS
•Substantial progress was made in designing and implementing a
highly complex intervention, and had brought together diverse
health and social care providers
•However, it was in the early stages of change and it was too
early to demonstrate benefits in terms of service use and patient
outcomes
•After year one a second pilot in outer North West London has
been established. Move towards a more ambitious ‘whole
systems’ approach based on risk stratification rather than disease
pathways, in both pilots
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Lessons for evaluation
•International evidence suggests a minimum of three to five
years before there is an impact on activity, patient experience
and outcomes
•Important to time evaluation accordingly and manage
expectations on when changes might become apparent (and
detectable)
•However there is value in continuous monitoring of outcomes,
particularly when contrasting change within the local context
with what is happening elsewhere
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Further information
www.nuffieldtrust.org.uk
http://www.nuffieldtrust.org.uk/publications/evaluationfirst-year-inner-north-west-london-integrated-care-pilot
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18 July 2015
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