Assessing outcomes of integrated care for long-term conditions

SPRU research team

Gillian Parker (Principal Investigator)
Fiona Aspinal
Sylvia Bernard
Gemma Spiers

Background

Recent policy promotes integrated care provision ‘to enable partners to join together to design and deliver services around the needs of users rather than worrying about the boundaries of their organisations’ (DH, 2008). It is assumed that these ‘arrangements should help eliminate unnecessary gaps and duplications between services’ (ibid). This emphasis on services rather than organisational structures in this most recent policy document is welcome, but leaves unresolved problems that have impeded earlier attempts to encourage integrated provision and takes for granted that we know that integrated care does make a difference, when the research literature is equivocal about this.

Aims

This research will:

explore models of integrated care and how the structures within which they are delivered impact on the model of integration
investigate the outcomes people with long-term neurological conditions value from an integrated approach to service delivery
develop ways of routinely assessing these outcomes of integrated services with those who provide innovative models of integrated care
explore if and how outcome assessment influences practice in different models of integrated care

Qualitative case studies will be undertaken to address the above objectives. Four case areas in England have been identified, each with an innovative model of integrated practice.

Services for people with long-term neurological conditions (LTNCs) will be used as an exemplar because people with LTNCs may pose complex challenges for effective health and social care integration. Adults with LTNCs are generally younger than most long-term users of health and social care services. As a result, their roles as partners, parents, and economically active adults should be considered as part of their overall needs. The ‘boundaries’ that are important thus go beyond the conventional ones of health and even of social care, making the task of co-ordination potentially more complex. For these and other reasons, we might expect mechanisms for integration that ‘get it right’ for people with LTNCs would also get it right for other adults with complex, long-term conditions. Using LTNCs as an exemplar would thus generate transferable knowledge.

Policy and practice aims

This project will produce messages about integrated health and social care that can be used elsewhere. This will include how structures and ways of working can support how integrated services are delivered at the individual level. It will indicate which models of integration offer potential for being implemented in other places. It will also outline the outcomes that people with LTNCs, rather than professionals, want from integrated services. It will demonstrate ways in which these outcomes can be used to influence the ways services are delivered.

Reference

Department of Health (2008) High Quality Care for All: NHS Next Stage Review final report, Cm 7432, The Stationery Office, London

Outcomes

Outcomes checklist

For practitioners to use when assessing a client's needs please apply here.

Outcomes framework

We identified three groups of outcomes important to people with LTNCs - LTNCO - Outcomes framework (PDF , 212kb)

Reports

How the checklist of outcomes worked in five different community-based, neuro-rehabilitation teams: