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1. A Systematic Assessment of
the Impacts of Integrated
Healthcare in UK
An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, Pubrica
Group: www.pubrica.com
Email: sales@pubrica.com

2. Methods
Literature Review search strategy
Collecting data for Literature Review
Evaluation of the risk of bias
Elements of models of integrated care
Conclusion
Outline
TODAY'S DISCUSSION

3. Growing financial and service demands in the UK
National Health Service (NHS) have been argued to
need a transformation in health and social care.
The NHS Five Year Forward View Plan, issued in 2014,
outlines how services must evolve and emphasizes the
need for greater care integration.
Increased service integration, it is suggested, will
enable the NHS to develop a financially sustainable
health and social care system by 2020.
Contd...

4. More care beyond the hospital walls, changes in the size
and design of acute hospitals, and increased attention to
prevention and public health are goals of the new
integrated care model.
This systematic review aimed at the effects of these new
integration models and research into whether models used
in other care systems may achieve similar results in the UK
National Health Service setting.

5. METHODS
Complex system-wide projects, such as integrated care
models, provide substantial challenges for systematic review
approaches.
Randomized experimental trials, known as the "gold
standard," have historically been employed in systematic
reviews to look for unambiguous intervention-outcome effects.
However, there has been significant growth in the number of
review methods accessible in recent years.
It has become evident that different review types are best for
addressing additional questions and fulfilling different aims.
Contd...

6. To accomplish the three goals of analyzing various forms of
integrated care initiatives and service delivery results,
combining studies of varied designs across the hierarchy of
evidence, and learning most relevant to the NHS in the
United Kingdom, we used a proper review technique.
As a result, we adopted a technique based on Pawson's
work, which emphasizes the necessity of accuracy and
relevance when analyzing complex outcome patterns.
Guidelines from the Cochrane Collaboration, the Institute
for Quality and Efficiency in Health Care, and the NHS
Economic Evaluation Database were used in this
systematic review research.

8. We used Medline, Embase, ISI Web of Knowledge, Cochrane Database of Systematic Reviews,
and Scopus to search five databases.
In each database, twenty-five expressions were entered (see supplementary material).
We also used Google to search the Internet, contacted specialists, and evaluated reference lists.

9. LITERATURE REVIEW
SEARCH STRATEGY
The study protocol was registered with the PROSPERO database and available on the National
Institute for Health Research website.
The conducting of literature review was conducted according to PRISMA (Preferred Reporting
Items for Systematic Reviews and Meta-Analyses) guidelines.

10. COLLECTING DATA FOR
LITERATURE REVIEW
Three reviewers assessed publication titles and abstracts (where
available) against the inclusion/exclusion criteria after the citations
were submitted to an EndNote database.
The entire team discussed any issues about inclusion at regular
(fortnightly) team meetings.

11. EVALUATION OF THE RISK OF BIAS
The hierarchy of research design and various checklists for each
study type were utilized to assess quality.
We investigated for sources of potential bias in studies that
employed a comparative method using the Cochrane criteria
(selection bias, performance bias, attrition bias, detection bias,
reporting bias).
We followed the National Institutes of Health recommendations
when using studies before and after (pre-post) designs with no
comparison group or published systematic reviews.
Instead of a numerical quality indicator, we did not evaluate
elements but offered a narrative.

12. ELEMENTS OF MODELS OF
INTEGRATED CARE
The majority of the integrated care models considered were
multi-element and sophisticated interventions.
The elements within them could be divided into four
categories: first, those aimed at directly improving patient
care; second, those aimed at changing organizations and
systems; third, those aimed at changing staff employment or
working practices; and finally, those aimed at financial or
governance aspects of integration.
Due to restricted reporting, many models included many
elements, making it difficult to decipher the form and
components.

13. We found the most elements in a single intervention to be nine, higher than comparable
integrated care efforts with only one element.
Models typically had four to six elements. In the international research, case manager/case co-
coordinator initiatives were more common, but integrated care pathways/plans were more
common in UK models.

14. CONCLUSION
Pubrica encourages systematic review services,
although the evidence for other objectives such as
service costs is uncertain, integrated care models
may improve patient happiness, raise the perceived
quality of care, and permit access to services.
Improved access might significantly impact services
that fail to meet rising demand.

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