EVALUATION OF INTEGRATED CASE MANAGEMENT (ICM) MEETINGS IN BEXLEY

Background and Rationale

Integrated care requires professionals and practitioners from across different sectors to work together around the needs of people, their families and their communities. Not working together results in a poor experience of care, a waste of resources and in some cases people suffering harm. Multidisciplinary teams (MDTs) are promoted as a means to enable practitioners and other professionals in health and social care to collaborate successfully. Multidisciplinary teams (MDTs) have been shown to be an effective tool to facilitate collaboration between professionals and hence improve care outcomes. The Social Care Institute for Excellence recognise the benefits of this approach while also calling for further evidence to enable us to understand how MDTs should be used in the future. Furthermore, many interventions found to be effective in pilot studies fail to translate in to meaningful patient outcomes when scaled-up. In response to this, there is a need to evaluate not only summative end point health outcomes, but also to perform formative evaluations to assess the extent to which implementation is effective in a specific context to maximise intervention benefits, prolong sustainability and promote dissemination of findings that can be used by other organisations to inform service design.

London Borough of Bexley MDTs

The Bexley approach to MDTs is the Integrated Case Management (ICM) programme. This is a collaborative partnership between the organisations involved in the delivery of health and care services including NHS Bexley CCG, Bexley Care, Oxleas NHS Foundation Trust, London Borough of Bexley (LBB), Bexley Health Neighbourhood Care the Bexley GP Federation (BHNC), hospital trusts, and community and voluntary sector providers. In addition NHS Bexley CCG has three GP leads, one in each Local Care Network (LCN), who are employed through Bexley’s GP Federation to provide clinical leadership to the programme. The ICM meetings include consultants, voluntary sector and specialist care partners to proactively manage complex individuals at high risk of future emergency admission to hospital. Patients are identified by GPs through a combination of risk stratification and clinical judgement and are not already in crisis or under discussion elsewhere.

Evaluation Approach

The evaluation of ICM meetings in Bexley was informed by implementation science. This is an ideal methodology to use as it facilitates the collection of data to identify and understand barriers to adoption, adaptation, scale-up and sustainability of evidence-based interventions (National Institutes of Health, 2015). Implementation science has long recognised the substantial gaps between innovations in health and their delivery in routine practice, and has advocated implementation research as a strategy to accomplish this translational work (Lomas 1993).

Historically, research on MDTs and integrated care has suffered from a poor evidence base as traditional cause and effect designs have failed to adequately consider the fluctuating context within which the services are implemented and rolled out. Outcome measures have also been employed that are insensitive to real changes that could be attributed to the intervention. Implementation science offers a different approach.

This suggested methodology connects to the need for an all-important examination of context, identification of change regarding implementation and resource use, who and what is affected and how, effects on user outcomes and experiences, identification of ‘active ingredients’ for transfer and aspects that are making a difference according to our chosen outcomes. It is also an ideal approach for the developmental nature of the ICM meetings in Bexley, enabling an evaluation of the roll out process since January 2018.