Department of Primary Care and Public Health, Reynolds Building, Charing Cross Campus, Imperial College London, London, UK W6 8RP.
Int J Integr Care. 2013 Mar 8;13:e006. doi: 10.5334/ijic.974. Print 2013 Jan-Mar.
Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect.
We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context.
This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them.
We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important.
英国国民保健署曾尝试过几次在当地引入综合护理，但收效甚微。 西北伦敦综合护理试点旨在通过在初级、二级和社会护理组织之间提供新的整合流程来改善老年人和糖尿病患者的护理质量。 它涉及预测风险建模、护理计划、复杂病例的多学科管理以及支持信息共享的信息技术工具。 本文介绍了为衡量其效果而采用的评估方法。
我们提出了一种混合方法评估方法。 它包括一种定量方法，使用常规的初级和二级数据源来衡量服务利用、成本、临床结果和护理质量的变化。 它还包含一个定性部分，涉及对患者和专业人员的观察、访谈和焦点小组，以了解参与者的经验并了解试点在国家政策背景下的情况。
本研究考虑了在不断变化的医疗经济环境中评估大型多组织干预措施的复杂性。 我们将评估置于复杂干预措施评估理论的框架内。 我们提出了评估此类干预措施所面临的具体挑战，以及为减轻这些挑战而采取的应对措施。
我们希望这种广泛、动态和响应式的评估能够使我们明确试点的贡献，并为评估其他类似干预措施提供潜在模型。 由于国际上各国政府对综合议程的重视，开发和改进强有力的评估方法仍然非常重要。
