- This briefing examines the early effects on hospital use of introducing multidisciplinary integrated care teams (ICTs) in North East Hampshire and Farnham (NEHF). It presents the findings of an evaluation conducted by the Improvement Analytics Unit, a partnership between NHS England and the Health Foundation
- The analysis shows that during the first 23 months of the programme’s implementation, patients referred to the ICTs attended A&E more frequently, and were admitted as an emergency more often, than the control group. This may be because the ICTs identified urgent unmet need amongst their patients or it may be that more time was needed for the benefits of ICTs on hospital use to be seen.
- In conclusion, a reduction in emergency hospital use may not be an appropriate objective for these type of multidisciplinary teams, at least in their early stages. Reducing emergency hospital use was only one of the objectives for ICTs in NEHF.
- There is evidence to suggest that the value of ICTs might lie in their potential to improve patients’ health, health confidence, experience of care and quality of life.
The Improvement Analytics Unit examined the early impact of ICTs on the hospital use of 774 patients in NEHF between July 2015, when the initiative was first introduced, and May 2017. The introduction of ICTs was one part of the Happy, Healthy, at Home primary and acute care system vanguard. In NEHF, ICTs are multidisciplinary teams that meet weekly to develop a care plan for each of their patients and provide more coordinated care.
We compared the hospital use of patients referred to an ICT with that of a matched control group who had not been referred to an ICT. The findings show ICT patients attended A&E 33% more often than the matched control patients in the period following referral to the ICT (95% confidence interval: 16-54% more often). ICT patients in the study experienced emergency admissions 43% more often than matched control patients (95% confidence interval: 23-67% more often).
In contrast, patients referred to an ICT were admitted electively 24% less often than the matched control patients (95% confidence interval: 2-41% lower).
Assuming the two groups did not differ in observed ways, we interpret these findings to show that the ICTs did not reduce A&E attendances and emergency admissions in the early stages (first 23 months) of its implementation and may even have led to increases.
We do not know what caused these results. It may be that the greater emergency hospital use of ICT patients was a result of ICTs identifying urgent needs for health care that might otherwise have remained unmet or only been identified later. Another explanation is that the ICTs led to patients being more aware of their health needs, which in turn led to patients attending A&E and being admitted.
This evaluation was conducted less than two years after implementation of the ICTs and does not evaluate the effect of the ICTs after June 2017. Other research has highlighted that implementing complex interventions needs time to take effect. It may be that more time is needed for the benefits of ICTs on hospital use to be seen. However, there is a question about whether reduction in emergency hospital use is an appropriate objective for ICTs, at least in their early stages.
This evaluation did not examine the impact of the ICTs in improving the coordination of care or improving patients’ health, health confidence, experience of care and quality of life. However, the value of integrated care teams might relate to improving these other areas rather than reducing emergency hospital admissions. It will be important to establish data collections that can monitor these aspects of care to help teams show impact, as well as to be realistic about what can be achieved in relation to reducing emergency admissions.
The ICTs in NEHF have continued to evolve and adapt to learning since the time of this study. The report states that there is still a need to monitor and evaluate the ongoing impact of the ICTs across a range of indicators.