Health Policy, Nuffield Trust, 59 New Cavendish Street, London, UK.
Int J Integr Care. 2013 Jul 25;13:e027. doi: 10.5334/ijic.1149. eCollection 2013.
This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support.
The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study).
The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes.
Although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. It is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.
本文介绍了对伦敦西北部一项大型综合护理试点计划进行的为期一年的评估结果。该试点计划旨在通过护理计划、多学科病例审查、信息共享和项目管理支持，将初级保健、急性护理、社区护理、心理健康和社会护理整合起来，为糖尿病患者和/或 75 岁以上的患者提供服务。
评估小组在组织、临床医生和患者层面进行了定性研究（使用访谈、焦点小组和调查）；并对服务使用和患者层面临床结果的变化进行了定量分析（使用患者层面的数据集和匹配的对照研究）。
该试点计划成功地使提供者组织参与其中，建立了共同的战略愿景，并建立了治理结构。然而，临床医生的参与情况各不相同，迄今为止，没有证据表明急诊入院人数有显著减少。有一些证据表明护理流程发生了变化。
尽管该试点计划已经展示了大规模变革的开端，但它仍处于早期阶段，在寻求更长期的可持续性方面面临重大挑战。国家卫生服务管理人员和临床医生必须对在相对较短的时间内可以实现的目标有现实的期望。
