North West London Integrated Care Pilot Evaluation: report on Work Programme 4 Understanding patient and provider experience and communication

Background
Integrated care pathways have long been advocated as a means to improving provision and continuity of care, as well as promoting interdisciplinary working. A more integrated health care system is thought to:
 provide greater continuity of care; care is organised across levels and settings, involving several professionals working together as an extended team
 reduce barriers for patients and offer faster access; care is redesigned so that patients flow through the system, removing artificial barriers and speeding up the patient journey
 reduce the number of visits to hospital; care is delivered in one-stop clinics with a range of professionals from several disciplines all working together within one co-ordinated system
 improve work processes for professionals; information flows better between providers and levels of care, through using interoperable systems and shared guidelines (Curry and Ham, 2010; Kodner and Spreeuwenberg, 2002).
The overall success, not only of the North West London (NWL) Integrated Care Pilot (ICP), but also of future initiatives of integrated care, depends on several conditions, including the development and implementation of: a) appropriate pathways that support the seamless delivery of care and enhance patient experience; b) re-organised work processes that support interdisciplinary work, facilitate workflow between and within levels of care and create a richer professional experience; and c) delivery models that work for both patients and providers.
At a practical level, the ICP involves three key interventions: the IT tool, the patient care plan and the multidisciplinary groups (MDGs). The IT tool facilitates the care planning, sharing of patient information between providers, and enables the stratification of patients with respect to their underlying condition and their estimated risk of hospitalisation. The aim of the patient care plan is to define multidisciplinary pathways incorporating both health and social care to assess the users’ needs in a single-point process and also to enable better monitoringof patients. Finally, the MDGs convene to discuss patient cases and comprise of GPs and representatives from the acute, mental health and social care trusts. MDGs are seen as key facilitators of integration, as moving from individual to multidisciplinary decision making, and from a focus on individual patients to a focus on patient groups, is the ICP’s overall objective. MDGs are opportunities for
participants to discuss, reflect on and develop strategies to change systems and processes within the local health economy. Therefore, communication in the MDGs is important to cultivating an integrative model of working, such that communication patterns may be useful to describe how the MDGs are working.
Although the effectiveness of the above interventions is key to meeting the ICP’s immediate objectives, sustainability of integration requires careful planning facilitated by realistic incentives, increased awareness and comprehensive costing. To ensure that the proposed model is feasible and sustainable, it needs to be able to address significant challenges and maximise limited resources to obtain better value for money, while improving the quality of health care and patient outcomes. To improve the sustainability of the ICP, it is important to understand the experiences of patients and professionals.
Aims
The overarching aim of this work package was to investigate the human perception, experience and involvement of providers and users in the ICP. To achieve this, we employed a mixed method approach to understand: the patients’ perceptions of provision and continuity of care; the providers’ perceptions of the implementation and sustainability of the ICP; and the patterns of participant communication during MDGs – one of the key interventions of the ICP.