Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Evidencing the quality and productivity of Allied Health Professionals' (AHPs...NHS Improvement
We recently hosted four regional events ‘Evidencing the quality and productivity of AHPs care’ with a target audience of Allied Health Professional leads in NHS provider organisations.
These slides outline sessions from the events and provide an introduction to the Model Hospital, AHP job planning and the early findings of a deployment tracker metric ‘Therapy Hours to Contacts’ that is being implemented.
his is the first in a series of interactive webinars designed to build capacity in the basic principles of knowledge translation and implementation science.
WATCH-ON DEMAND: https://goo.gl/hnp8gi
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Professor Kamlesh Khunti - Introduction to CLAHRC East MidlandsCLAHRC-NDL
Professor Kamlesh Khunti, Director of NIHR CLAHRC East Midlands - Introductory presentation given at CLAHRC East Midlands launch event, 14 February 2014, Loughborough.
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Greater Manchester's visionary approach to integrated care
Delivered by the Greater Manchester Health and Social Care Partnership
Day Two, Pop-up University 8, 16.00
The Nuts & Bolts of Integrating Health Technology Assessment in Care Pathways...Brenda Rehaluk
This MA organizational change project was sponsored by the Alberta Health Services (AHS), Strategic Clinical Network, Health Technology Assessment and Adoption (SCN, HTAA) team. This research project's overarching question was on how can health technology assessment be used effectively in clinical care pathways and clinical practice guideline development.
Findings: Health technology assessment (HTA) creates a common language among health care providers to improve engagement and patient centred care. Optimization of health technology assessment involves the development of relationships, education, and simple technological tools to create a culture of HTA acceptance.
Beacon Medical Group - A Disruption Mindset presentation to RCGPClaire Oatway
Disruption is all around us and healthcare as we know it will never be the same again. Lets not be despondent or reactive to this - disruption gives us really opportunities to break the mould and as GPs provide the clinical leadership our communities need us to.
We were delighted to share the presentation we made at the recent Royal College of General Practitioners - Changing Face of Primary Care event - March 2016.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Evidencing the quality and productivity of Allied Health Professionals' (AHPs...NHS Improvement
We recently hosted four regional events ‘Evidencing the quality and productivity of AHPs care’ with a target audience of Allied Health Professional leads in NHS provider organisations.
These slides outline sessions from the events and provide an introduction to the Model Hospital, AHP job planning and the early findings of a deployment tracker metric ‘Therapy Hours to Contacts’ that is being implemented.
his is the first in a series of interactive webinars designed to build capacity in the basic principles of knowledge translation and implementation science.
WATCH-ON DEMAND: https://goo.gl/hnp8gi
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Professor Kamlesh Khunti - Introduction to CLAHRC East MidlandsCLAHRC-NDL
Professor Kamlesh Khunti, Director of NIHR CLAHRC East Midlands - Introductory presentation given at CLAHRC East Midlands launch event, 14 February 2014, Loughborough.
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Greater Manchester's visionary approach to integrated care
Delivered by the Greater Manchester Health and Social Care Partnership
Day Two, Pop-up University 8, 16.00
The Nuts & Bolts of Integrating Health Technology Assessment in Care Pathways...Brenda Rehaluk
This MA organizational change project was sponsored by the Alberta Health Services (AHS), Strategic Clinical Network, Health Technology Assessment and Adoption (SCN, HTAA) team. This research project's overarching question was on how can health technology assessment be used effectively in clinical care pathways and clinical practice guideline development.
Findings: Health technology assessment (HTA) creates a common language among health care providers to improve engagement and patient centred care. Optimization of health technology assessment involves the development of relationships, education, and simple technological tools to create a culture of HTA acceptance.
Beacon Medical Group - A Disruption Mindset presentation to RCGPClaire Oatway
Disruption is all around us and healthcare as we know it will never be the same again. Lets not be despondent or reactive to this - disruption gives us really opportunities to break the mould and as GPs provide the clinical leadership our communities need us to.
We were delighted to share the presentation we made at the recent Royal College of General Practitioners - Changing Face of Primary Care event - March 2016.
Judith Smith and Chris Ham: Commissioning integrated care - what role for cli...The King's Fund
Dr Judith Smith, Head of Policy at the Nuffield Trust, and Professor Chris Ham, Chief Executive of The King’s Fund, share the findings of their recent research into how NHS commissioners have been commissioning better integrated services and care for people in local areas.
Magnus Liungman: RCTs in complex settings Nuffield Trust
Magnus Liungman and Dr Gustaf Edgren present on the lessons learned from developing a healthcare prevention intervention for frequent emergency department visitors.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
Mixed method design is often noted as a methodology capitalizing on the advantage of in-depth study in qualitative approaches and the power of generalization in quantitative approaches.
To be useful, acknowledging the fundamental assumption underpinning these two approaches is paramount. Qualitative approach is individualistic where the findings are rich in explaining a phenomenon of interest in context while quantitative approach is normative where the findings represent an average pattern of a phenomenon of interest in a population.
Our current approach to root causeanalysis is it contributi.docxgerardkortney
Our current approach to root cause
analysis: is it contributing to our
failure to improve patient safety?
Kathryn M Kellogg,1 Zach Hettinger,1 Manish Shah,2 Robert L Wears,3
Craig R Sellers,4 Melissa Squires,5 Rollin J Fairbanks1
ABSTRACT
Background Despite over a decade of efforts to
reduce the adverse event rate in healthcare, the
rate has remained relatively unchanged. Root
cause analysis (RCA) is a process used by
hospitals in an attempt to reduce adverse event
rates; however, the outputs of this process have
not been well studied in healthcare. This study
aimed to examine the types of solutions
proposed in RCAs over an 8-year period at a
major academic medical institution.
Methods All state-reportable adverse events
were gathered, and those for which an RCA was
performed were analysed. A consensus rating
process was used to determine a severity rating
for each case. A qualitative approach was used
to categorise the types of solutions proposed by
the RCA team in each case and descriptive
statistics were calculated.
Results 302 RCAs were reviewed. The most
common event types involved a procedure
complication, followed by cardiopulmonary
arrest, neurological deficit and retained foreign
body. In 106 RCAs, solutions were proposed.
A large proportion (38.7%) of RCAs with
solutions proposed involved a patient death. Of
the 731 proposed solutions, the most common
solution types were training (20%), process
change (19.6%) and policy reinforcement
(15.2%). We found that multiple event types
were repeated in the study period, despite
repeated RCAs.
Conclusions This study found that the most
commonly proposed solutions were weaker
actions, which were less likely to decrease event
recurrence. These findings support recent
attempts to improve the RCA process and to
develop guidance for the creation of effective
and sustainable solutions to be used by RCA
teams.
INTRODUCTION
The problem of morbidity and mortality
from adverse events in healthcare has
undergone over 15 years of intense scru-
tiny, funding, regulation and research
worldwide. Despite dramatically intensi-
fied efforts to increase the safety of the
healthcare system, reports have suggested
that safety has not improved. The adverse
event rate has remained essentially the
same, suggesting that our current solu-
tions to the problem are not working.1–10
This lack of progress persists despite the
devotion of a tremendous amount of
financial and human resources at the
local, state and national levels in an effort
to reduce errors and patient harm.11
One common, resource-intensive, prac-
tice is the root cause analysis (RCA)
process, which is used by most hospitals
in the USA.12–15 The RCA process has
been mandated in response to sentinel
events by the Joint Commission since
1997.16 Although the RCA process has
been presumed to induce change, its
effectiveness has been questioned and
there is not robust literature to support
its efficacy.17 18 In healthcare, there are
reports of difficul.
NGS-based diagnostic testing compared to single-marker genetic testing (SMGT), has the potential to improve testing efficiency and to identify more cancer patients who could benefit from targeted therapies, but the impact on outcomes and total costs of care is uncertain. Recent studies using simulation modeling informed with data from the Flatiron Health database, representing curated electronic health record-derived clinical information from 191 oncology practices, has shown only moderate cost effectiveness of NGS vs. SGMT for patients with advanced non-small cell lung cancer (aNSCLC). The data suggests, however, that efforts to increase the proportion of patients who receive targeted therapies would improve the cost-effectiveness of NGS. To effectively inform access and reimbursement policy decisions there is a need to examine the NGS value proposition from the perspective of all stakeholders.
Author(s) and affiliation(s): Lotte Steuten (Office of Health Economics, London, UK); Bernardo Goulart (Fred Hutchinson Cancer Research Center, Seattle, WA, US & Seattle Cancer Care Alliance, Seattle, WA, US); Neal J. Meropol (Flatiron Health, New York, NY, US & Case Western Reserve University, Cleveland, OH, US); Daryl Pritchard (Personalized Medicine Coalition, Washington, DC, US); and Scott D. Ramsey (Fred Hutchinson Cancer Research Center, Seattle, WA, US)
Event: ISPOR 2019
Location: New Orleans, LA, United States
Date: 20/05/2019
Let's Talk Research Annual Conference - 24th-25th September 2014 (Dr Sally Gi...NHSNWRD
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MicroGuide app, pop up uni, 1pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Leveraging Predictive Models to Reduce ReadmissionsHealth Catalyst
Far too often analytics efforts have fallen short of making a tangible impact on outcomes because they haven’t been successfully implemented in real workflows. Predictive models remain at risk of becoming isolated in their use along the continuum of care where their integration may provide benefits larger than the sum of each silo.
To combat this, UnityPoint Health (UPH) focused on integrating analytical models within the same readmission reduction strategy and coaching the care team to facilitate their adoption. Using this approach, one of UPH hospital’s risk-adjusted readmission indexes improved 40 percent over three years, surpassing internal system targets in performance and becoming the top performer in the health system.
Learning Objectives:
- Describe applicable predictive models useful in reducing 30-day readmissions.
- Learn the elements of a successful readmissions reduction strategy in an integrated health system.
- Understand common obstacles faced in the adoption of analytical tools and how to overcome them.
View this webinar to gain knowledge of the analytics tools and methods UPH used, including innovative individualized risk heat-maps generated for each patient, strategies for analytics adoption, and lessons learned along the way.
Patient-Centered Care Requires Patient-Centered Insight: What We Can Do To C...Health Catalyst
Health systems and providers are inundated with measurement systems and reporting. Why would we want to add to the measurement mayhem? The real question is, “Are we measuring what matters?”
Carolyn Simpkins MD, PhD, chief medical informatics officer, will discuss how putting the patient at the center of the measurement matrix can bring coherence and completeness to the picture of care delivery performance across the patient journey, and therefore the performance of the healthcare ecosystem.
She will describe the building blocks for patient-centered measurement and how other metrics, patient-reported outcomes, and patient satisfaction fit into this approach. Carolyn will also review the challenges that have kept health systems from completing a patient-centered outcomes approach and why we are poised to break through. Finally, she will share case studies of organizations who have begun to pioneer the use of patient centered metrics to improve care and outcomes.
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Effectiveness of the current dominant approach to integrated care in the NHS
1. Greater Manchester
Primary Care Patient Safety
Translational Research Centre
Effectiveness of the current dominant approach to integrated
care in the NHS: A systematic review of case management
Jonathan Stokes
This presentation summarises independent research funded by the NIHR Greater Manchester PSTRC.
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the
Department of Health.
3. Background
Integrated Care
Greater Manchester Primary Care Patient Safety Translational Research Centre
“create connectivity, alignment and collaboration” (Kodner & Spreeuwenberg, 2002)
Integrated care examples - Kodner & Spreeuwenberg, 2002
Health system framework - Atun et al, 2013
175 definitions!! (Armitage et al 2009)
4. Integrated care in the English NHS
Greater Manchester Primary Care Patient Safety Translational Research Centre
Effectiveness of this model not been subjected to rigorous
quantitative synthesis across all health system goals
Integrated care emphasis Percentage of CCGs
Multidisciplinary team case management (MDT):
Identification of high risk groups (usually using a risk-stratification tool),
implementation of a structured care plan, and regular monitoring by a
multidisciplinary team based at the primary care level (often involving a social
worker)
81%
Other case management:
Similar to the above model, but the care plan is implemented and regularly
monitored by a single, dedicated case manager (often a practice nurse, or an
intensive case manager)
14%
Joint planning and commissioning:
Integrated care emphasis placed on establishing better links with the Local
Authority and other organisational links e.g. through joined up plans and multi-
agency boards
5%
10% random sample of 211 CCGs (2013)
Publically available documents reviewed – what each branding as integrated care?
5. Methods
Study Selection
Greater Manchester Primary Care Patient Safety Translational Research Centre
Population:
Adults (18+) with long-term conditions
Intervention:
Identifying ‘at-risk’ patients to case
manage
Case management
Primary care/community-based
Comparison:
Usual care or no-case management
Outcomes:
Health – self-assessed health status,
mortality;
Cost – total cost of care, healthcare
utilisation (primary and non-specialist
care and secondary care separately), and;
Satisfaction – patient satisfaction
Study design:
Cochrane EPOC methodology (RCT, nRCT,
CBA, ITS)
Search strategy
Databases
MEDLINE
EMBASE
CINAHL
Cochrane (CENTRAL)
HMIC
CAB Global Health
Blocks of search terms
1. Case management
2. EPOC methodology filter
3. Primary care filter
Exclusions
• Mental health only
• Hospital discharge
planning
• Non-English
language/ grey
literature
Quality
EPOC Risk of bias tool
6. Methods
Data Analysis
Greater Manchester Primary Care Patient Safety Translational Research Centre
Quantitative data extracted
Self-assessed health status
• (Instrumental/) Activities of Daily Living
• Physical/ mental health questionnaires
• Bed days/ restricted activity days
• Quality Adjusted Life Years (QALYs)
Mortality
• Mortality within study period
Total cost of services
• Total cost
• Total insurance expenditure/ reimbursement
Utilisation of primary and non-specialist care
• Primary care physician visits
• Home care visits
• Social worker visits
• Nursing visits
Utilisation of secondary care
• Emergency Department visits
• Hospital admissions/ re-admissions/ days
• Inpatient/outpatient utilisation
• Skilled nursing facility visits/ days
• Ambulance calls
• Specialist visits
Patient satisfaction
• Patient satisfaction questionnaires
• Patient quality of care ratings
Short-term
(0-12 months)
Long-term
(13+ months)
Heterogeneity: I2
Small study bias: Funnel
plots/Egger’s test
Random Effects Model
7. Results
Studies included
Greater Manchester Primary Care Patient Safety Translational Research Centre
• mean age: 75.7 (49.0 to
87.3)
• setting: 64% Low PHC
strength
• patients: 8% Specific
conditions
• intervention: 58% MDT
case management; 33%
Social worker involved
• design: 78% RCT
• follow-up: 6 to 60 months
• quality (9 criteria): 64%
7+; 30% 4-6; 6% 3-
9. Results
Meta-analysis
Greater Manchester Primary Care Patient Safety Translational Research Centre
Cost
No. of studies:
Utilisation of primary care
16
7
Utilisation of secondary care
23
16
Total cost of services
8
5
11. Discussion
Summary of findings
Greater Manchester Primary Care Patient Safety Translational Research Centre
• Case management has been promoted as a way of reducing health system
pressures
• This review does not provide strong evidence to support this promotion
• total cost of care, and utilisation of secondary care services do not appear
to be significantly affected
• may be significant effect on self-reported health status (short-term: 0.07;
0.00 to 0.14)
• does seem to improve patient satisfaction (short-term: 0.26; 0.16 to
0.36/ long-term: 0.35; 0.04 to 0.66)
Cohen, 1988
• Current results rest on the evidence accumulated from (mostly) RCTs and in
high-income settings. Only assess direct effects
• Evidence from subgroup analyses suggest there may be more effective ways of
delivering the intervention (e.g. by an MDT, with a social worker involved, in a
health system ranked as weak in primary care - see publication)
12. Discussion
Aim of integration
Greater Manchester Primary Care Patient Safety Translational Research Centre
• No evidence that currently integrated care will be the magic bullet hoped to
be:
• Cost/utilisation
• Health benefits
• Satisfaction
• Conflict between NHS ‘patient-centered’ definition (aim!) of integrated care
and what commissioners want it to achieve?
• Satisfaction (patient experience of care) v Cost
• E.g. Fenton et al, 2012 – ‘The cost of satisfaction’
• What do we want integrated care to achieve?... And is it able to?
13. Discussion
Focus on high-risk groups
Greater Manchester Primary Care Patient Safety Translational Research Centre
• Highest risk patients may legitimately require the additional care
• Better identifying these patients can uncover unmet need, and so potentially
increase costly utilisation
• Current risk prediction models primarily based on previous healthcare
utilisation data (so already well-known to services)
Identifying
high-risk
Identifying
preventable
admissions
14. Discussion
Alternative means of integration
Greater Manchester Primary Care Patient Safety Translational Research Centre
Integrated care examples - Kodner & Spreeuwenberg, 2002
Health system framework - Atun et al, 2013
15. Discussion
Organisational integration – e.g. ACOs
Greater Manchester Primary Care Patient Safety Translational Research Centre
• NHS England (Macro-environment)
• GP independently-contracted
• Choice and competition agenda
McLellan et al, 2015
McWilliams et al, 2016
• Multiple providers of IT systems
that don’t link up
16. Discussion
Determinants of health outcomes – potential of models of care
Greater Manchester Primary Care Patient Safety Translational Research Centre
McGovern et al, 2014
17. Discussion
Alternatives to integrated care?
Greater Manchester Primary Care Patient Safety Translational Research Centre
• Addressing current funding gap is most pressing challenge
• Prevention/early intervention?
• Some evidence of ability to reduce demand (Purdy, 2010)…but likely
to take a long time
• Expansion of primary care?
• Some evidence of reduced emergency admissions for minor
conditions (Whittaker et al, 2016)
• Will only realise cost savings if secondary care services
decommissioned
• Workforce problems, e.g. lack of GPs
• Address funding gap directly?
• Health expenditure per capita
• Reverse ‘self-inflicted’ demand increases?
• Austerity choices (e.g. public health, social care budgets, etc.)
• Privatisation
• PFI, Consultancy/Agency staff
18. Acknowledgements
Supervisors:
• Peter Bower
• Kath Checkland
• Søren Rud Kristensen
• Sudeh Cheraghi-Sohi
Other Co-authors:
• Maria Panagioti
• Rahul Alam
Greater Manchester Primary Care Patient Safety Translational Research Centre
19. A partnership between
The NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre
is funded by the National Institute for Health Research (NIHR) and is a partnership between the
University of Manchester and Salford Royal NHS Foundation Trust