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National Evaluation of the Department of Health’s Integrated Care Pilots Appendices RAND Europe, Ernst & Young LLP Prepared for the Department of Health March 2012 The research described in this document was prepared for the Department of Health. RAND Europe is an independent, not-for-profit research organisation whose mission is to improve policy and decision making for the public good. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Ernst & Young is a global leader in assurance, tax, transaction and advisory services. Worldwide, our 152,000 people are united by our shared values and an unwavering commitment to quality. We make a difference by helping our people, our clients and our wider communities achieve their potential. Ernst & Young refers to the global organization of member firms of Ernst & Young Global Limited, each of which is a separate legal entity. 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Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 Westbrook Centre, Milton Road, Cambridge CB4 1YG, United Kingdom RAND URL: http://www.rand.org RAND Europe URL: http://www.rand.org/randeurope To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] National Evaluation of the DH Integrated Care Pilots 2 List of Appendices Appendix A: Study protocol Appendix B: Quantitative methods Appendix C: Patient-service user questionnaire Appendix D: Staff questionnaire Appendix E: Template for collecting data from sites Appendix F: Summary of local metrics Appendix G: Site overviews Appendix H: Detailed results of patient and staff survey Appendix I: Costs reported by sites Integrated Care Pilots evaluation: final report Appendix A: Study protocol 1 International Journal of Integrated Care – ISSN 1568-4156 Volume 10, 27 September 2010 URL:http://www.ijic.org URN:NBN:NL:UI:10-1-100969 Publisher: Igitur, Utrecht Publishing & Archiving Services Copyright: Research and Theory Evaluation of UK Integrated Care Pilots: research protocol Tom Ling, Director, Evaluation and Audit, RAND Europe, Westbrook Centre, Westbrook Centre, Milton Road, Cambridge CB4 1YG, UK Martin Bardsley, Head of Research, Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK John Adams, Senior Statistician, RAND Health, 1776 Main Street, Santa Monica, CA 90401-3208, USA Richard Lewis, Partner, Ernst and Young LLP, 1 More London Place, London SE1 2AF, UK Martin Roland, Professor of Health Services Research, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK Correspondence to: Martin Roland, Professor of Health Services Research, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK, Phone: +44 1223 330329, Fax: +44 1223 762515, E-mail: [email protected] Abstract Background: In response to concerns that the needs of the aging population for well-integrated care were increasing, the English National Health Service (NHS) appointed 16 Integrated Care Pilots following a national competition. The pilots have a range of aims including development of new organisational structures to support integration, changes in staff roles, reducing unscheduled emergency hospital admissions, reduced length of hospital stay, increasing patient satisfaction, and reducing cost. This paper describes the evaluation of the initiative which has been commissioned. Study design and data collection methods: A mixed methods approach has been adopted including interviews with staff and patients, non-participant observation of meetings, structured written feedback from sites, questionnaires to patients and staff, and analysis of rou- tinely collected hospital utilisation data for patients/service users. The qualitative analysis aims to identify the approaches taken to integra- tion by the sites, the benefits which result, the context in which benefits have resulted, and the mechanisms by which they occur. Methods of analysis: The quantitative analysis adopts a ‘difference in differences’ approach comparing health care utilisation before and after the intervention with risk-matched controls. The qualitative data analysis adopts a ‘theory of change’ approach in which we triangulate data from the quantitative analysis with qualitative data in order to describe causal effects (what happens when an independent variable changes) and causal mechanisms (what connects causes to their effects). An economic analysis will identify what incremental resources are required to make integration succeed and how they can be combined efficiently to produce better outcomes for patients. Conclusion: This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in par- ticular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare. Keywords integrated care, evaluation, protocol This article is published in a peer reviewed section of the International Journal of Integrated Care 1 International Journal of Integrated Care – Vol. 10, 27 September 2010 – ISSN 1568-4156 – http://www.ijic.org/ Background in healthcare costs (Table 1). One of the conclusions of this and other reviews is that the effectiveness of There are growing numbers of people with chronic con- attempts to provide better integrated care is highly ditions with a particularly rapid rise in the number with dependent on the context in which the intervention multiple care needs. The complex needs of people with takes place. Interventions cannot be seen separated multiple chronic conditions require the development of from the context in which they are introduced, and this delivery systems that bring together a range of profes- has been an important guiding principle in the evalua- sionals and skills from both the cure and care sectors tion described in this paper. to meet those needs. Despite this, service delivery has In response to concerns that the needs of the aging developed in ways that have tended to fragment care, population for well-integrated care were increasing, both within and between sectors, through for example the UK Department of Health for England announced structural and financial barriers dividing providers at the in 2008 that a number of ‘Integrated Care Pilots’ would primary/secondary care and at the health and social be established. Healthcare purchasers and provid- care interface; distinct organizational and professional ers were invited to submit proposals for innovative cultures; and differences in terms of governance and approaches to providing better integrated care [3]. accountability [1]. There was no specification as to the form that such A substantial number of evaluations have been carried integration should take, or client groups who should out of interventions designed to improve the integra- receive the intervention. There were over 100 appli- tion or coordination of care. A systematic review based