National evaluation of integrated care pilots

The aim of the Department of Health’s integrated care pilots was to explore different ways of providing integrated care to help drive improvements in care and well being. The pilots were designed to look beyond traditional boundaries of care, for example between primary and secondary care or between health and social care, in order to develop new, more integrated models of service delivery.

The Department of Health appointed Ernst & Young, RAND Europe and the University of Cambridge to evaluate the integrated care pilots, and researchers at the Nuffield Trust supported the evaluation by using an innovative method that links anonymous patient records over time.

By using this data linkage method – which is designed not to compromise patient confidentiality – we were able to study the hospital use of individual patients in the integrated organisations and show how hospital use changed over time.

The summary results of our work showed that although in general the integrated care sites had lower than expected outpatient and elective care, there was no evidence that these sites were reducing the level of emergency hospital care

Furthermore, we were able to generate a matched control group from elsewhere in the country, using methods applied to the evaluation of the Partnership for Older People (POPP) project. These steps were important to ensure that any changes seen in hospital use were not simply due to services shifting their focus towards lower risk patients over time.

We looked at individual patients from eleven integrated care projects and assessed the ‘risk profile’ of every patient seen by the pilots, so that we could adjust the results accordingly. Six of the pilots could broadly be classified as offering some form of case management.

The summary results of our work showed that although in general the integrated care sites had lower than expected outpatient and elective care, there was no evidence that these sites were reducing the level of emergency hospital care. Overall, secondary hospital care costs for patients were not any lower than expected.

The full evaluation looked at patient and staff views as well as qualitative studies of the way these organisations operated. The full report of the evaluation of the pilots is available to download from the Department of Health’s website.

The report looks at many other elements of the organisations and it is important to remember that:

• The projects within the pilot scheme were very varied in terms of scale and scope of integration;
• Changes in hospital use are just one potential change that arises from greater integration;
• Not all integrated care organisations (ICOs) were expected to have the same impact on hospital activity;
• Changing organisations and subsequent care delivery can take a long time. These studies mainly focused on organisations that were very new.

We are planning that our findings will form part of a paper for a peer reviewed journal. This work will also contribute to a report that aims to give a broad overview of the impact of a range of innovations aimed at reducing the need for secondary care – this report is planned for publication later this year.