Is integration of primary, secondary and social care better for patients and is it cost effective? Andrew Street, Professor of Health Economics, discusses a recent paper he published with co-authors Anne Mason and Panagiotis Kasteridis, which evaluated the cost-effectiveness of integrated care (IC) programmes in South Somerset for people with long-term conditions.
Objectives: As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. The authors assessed their impact on a range of utilization measures and mortality.
- Complex Care Team (CCT), provides senior medical input, care coordination, and a personalized care plan to support self-care.
- Staffed by GPs with expertise in chronic care management, complex care nurses and other keyworkers, the CCTs aim to prevent avoidable hospitalizations or, for those in hospital, to support appropriate inpatient care.
Methods: They used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models. The analysis sample included 564 Complex Care Team and 841 Enhanced Primary Care cases that met specific criteria.
They employed propensity score methods to identify out-of-area control patients and difference-in-differences analysis to isolate the care models’ impact.
Results: They found no evidence of significantly reduced utilization in any of the Complex Care Team or Enhanced Primary Care cohorts. The death rate was significantly lower only for those in the first Enhanced Primary Care cohort.
Conclusions: The integrated care models did not significantly reduce utilization nor consistently reduce mortality. Future research should test longer-term outcomes associated with the new models of care and quantify their contribution in the context of broader initiatives.
Watch Andrew Street explaining the article (5m)
Photo Richard Long 2012 A circle in Antartica