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Integrated care pilots a success

Pilots produced better care processes, happier staff and lower hospital use

Louise Prime

Friday, 23 March 2012

Patients benefited from higher quality of care in sites involved in the Integrated Care Pilot programme – while at the same time staff became more satisfied – a large independent study has found. It also reported a reduction in hospital costs.

The pilots tried several different ways of integrating care: between general practices, community nurses, hospitals and social services. The University of Cambridge was commissioned by the Department of Health to work with Ernst & Young and RAND Europe to assess over two years the effect of integrated care pilots at 16 different sites across England. They looked at the pilots’ impact on elderly people at risk of emergency hospital admissions, and on the management of conditions such as dementia and mental illness.

The study found that where integration was well led and well managed, and tailored to local circumstances, care quality was improved, staff liked the changes and hospital costs were reduced. It found:

  • 60% of staff thought they worked more closely with other team members
  • 72% of staff reported better communication with other organisations
  • 84% of staff said their job had expanded, and 64% that their role had become more interesting
  • 54% of staff overall thought patient care had improved as a result of the pilot.

In pilots where there was a focus on identifying at-risk elderly people and then having a case manager coordinate their care, outpatient visits decreased by 22% and planned admissions by 21% – leading to a 9% fall in overall costs of hospital care.

Martin Roland, professor of health services research at the University of Cambridge and co-leader of the research, said: “Improvement in care processes is certainly a key benefit of integrated care, but we cannot afford to lose sight of the patient who may have a different perspective on the services they receive, such as the importance of having continuity of care from doctors and nurses.

“We have also seen how difficult it is to reduce emergency admissions for vulnerable elderly people even when everything appears to be set up to manage demand for hospital admission. This is not the first study with such findings suggesting that there may be genuine unmet need among this group of patients and that services should be planned taking this into account.

“However, the study also shows the potential to move other types of care from hospital into the community, for example reducing the need for outpatient attendance.”

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