New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis

Morciano, Marcello; Checkland, Kath; Billings, Jenny R.; Coleman, Anna; Stokes, Jonathan; Tallack, Charles; Sutton, Matt

doi:10.1016/j.healthpol.2020.06.004

Cited by 46 publications

(59 citation statements)

References 20 publications

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“…24 An analysis of a pooled sample of all 23 populationbased Vanguard models also found no significant reduction in emergency admissions over three years in total, although there was some evidence of a relative net reduction compared to controls in the third year. 25 This points to possible improvements over the longerterm, but the findings are not comparable on the precise measures we used in our analysis.…”

Section: Results In Contextmentioning

confidence: 81%

Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England

Stokes

Shah

Goldzahl

et al. 2020

J Health Serv Res Policy

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Objectives To examine the effectiveness of two integrated care models (‘vanguards’) in Salford and South Somerset in England, United Kingdom, in relation to patient experience, health outcomes and costs of care (the ‘triple aim’). Methods We used difference-in-differences analysis combined with propensity score weighting to compare the two care model sites with control (‘usual care’) areas in the rest of England. We estimated combined and separate annual effects in the three years following introduction of the new care model, using the national General Practice Patient Survey (GPPS) to measure patient experience (inter-organisational support with chronic condition management) and generic health status (EQ-5D); and hospital episode statistics (HES) data to measure total costs of secondary care. As secondary outcomes we measured proxies for improved prevention: cost per user of secondary care (severity); avoidable emergency admissions; and primary care utilisation. Results Both intervention sites showed an increase in total costs of secondary care (approximately £74 per registered patient per year in Salford, £45 in South Somerset) and cost per user of secondary care (£130–138 per person per year). There were no statistically significant effects on health status or patient experience of care. There was a more apparent short-term negative effect on measured outcomes in South Somerset, in terms of increased costs and avoidable emergency admissions, but these reduced over time. Conclusion New care models such as those implemented within the Vanguard programme in England might lead to unintended secondary care cost increases in the short to medium term. Cost increases appeared to be driven by average patient severity increases in hospital. Prevention-focused population health management models of integrated care, like previous more targeted models, do not immediately improve the health system’s triple aim.

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Section: Results In Contextmentioning

confidence: 81%

Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England

Stokes

Shah

Goldzahl

et al. 2020

J Health Serv Res Policy

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“…First, we were not able to account for local contextual factors which might have affected the adoption and implementation of integration processes. Moreover, implemented initiatives were heterogeneous across sites and difficult to describe in detail using interviews and documentary analysis [15,19,[32][33][34][35][36][37]. A recent evidence synthesis of 115 local Vanguard evaluation reports concluded that none of the reports offered "explanations and/or nuanced insights into the Vanguard operation" [38], making crossinitiatives comparisons difficult.…”

Section: Discussionmentioning

confidence: 99%

“…An intensive support programme led by NHSE was established to facilitate the development and spread of new models of care within and beyond the Vanguards, with the following elements [17]:…”

Section: New Care Model Vanguard Programme 2015-18mentioning

confidence: 99%

“…Hitherto, the Pioneer or Vanguard programmes have been studied separately [15,19,[32][33][34][35][36][37][38], but never in combination. However, a number of Pioneers subsequently applied to become Vanguards, and thus the two programmes overlapped in time and partially in place.…”

Section: Comparing the Impact Of The Pioneer And Vanguard Programmesmentioning

confidence: 99%

“…Reducing emergency admission rates has been a feature of English health policy over the past decade and continues to be one of the most commonly used measures of success for system change initiatives [12][13][14]. While recent initiatives have begun with a range of objectives including improving patient and carer experiences, policy and system objectives have tended to narrow over time leading to a strong emphasis on reductions in emergency admissions [15][16][17][18][19]. To date, however, there has been little evidence of initiatives successfully reducing emergency admissions [20][21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

Morciano

Checkland

Durand

et al. 2021

BMC Health Serv Res

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Background Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

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Market concentration, supply, quality and prices paid by local authorities in the English care home market

et al. 2021

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We investigate the impact of exogenous local conditions which favor high market concentration on supply, price and quality in local markets for care homes for older people in England. We extend the existing literature in: (i) considering supply capacity as a market outcome alongside price and quality; (ii) taking account of the chain structure of care home supply and differences between the nursing home and residential care home sectors; (iii) using an econometric approach based on reduced form relationships that treats market concentration as a jointly determined outcome of a complex market. We find that areas susceptible to a high degree of market concentration tend to have greatly restricted supply of care home places and (to a lesser extent) a higher average public cost, than areas susceptible to low degree of market concentration. There is no significant evidence that conditions favoring high market concentration affect average care home quality.

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New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis

Cited by 46 publications

References 20 publications

Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England

Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

Market concentration, supply, quality and prices paid by local authorities in the English care home market

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