Supporting the local decision-making process in England in the context of integrated Care
Developing an analytical framework to support commissioners and other local health authorities in England to assess integrated care services and make an efficient and accountable allocation of resources on the basis of public values and stakeholders’ preferences.
Part of our Improving Health and Social Care research theme
Economic evaluation in integrated care is still in its early years. […] However, the urge for a wider implementation of integrated care to address the needs of people with chronic conditions and improve efficiency calls for more evidence-based decision-making based on thorough economic evaluations”- Dr Apostolos Tsiachristas, Associate Professor, Nuffield Department of Population Health, University of Oxford
Integrated health programs are complex and local commissioners in England are generally interested in multiple and often conflicting criteria. In addition, the new emphasis on collaboration and integration demands local commissioners to take into account views and information from all stakeholders.
Some studies have pointed out that local commissioners do not have enough capacity to use all available evidence and make well-informed decisions.
A transparent and friendly priority-setting tool, that explicitly incorporates all relevant criteria, could facilitate the commissioning of integrated care programmes.
To do this we will:
- describe the local commissioning decision context in England and will identify the main constraints that decision-makers face when assessing health interventions and making budget allocation decisions;
- conduct a systematic literature review and work together with local stakeholders, throughout workshops and semi-structured interviews, to identify relevant assessment criteria (e.g. health outcomes, financial burden, patient satisfaction, access) and assess relative preferences;
- use existing routinely collected data by local health authorities conducive to assess the performance of 1 or 2 integrated health interventions using quasi-experimental methods; and
- develop a decision tool, based on a multi-criteria decision analysis approach, that commissioners can easily use to assess and monitor integrated care services.
How we are involving patients and the public
When identifying the relevant criteria by which integrated care interventions should be evaluated, we will conduct facilitated workshops with representatives of local health authorities (such as CCGs and city councils), patients and their partners, health and social care providers, carers and organisations from the voluntary sector.
How we are planning to implement the research outputs
We are working closely with local commissioners in order to better understand the difficulties they face when making prioritisation decisions in the context of integrated care models. In addition, when identifying all relevant prioritisation criteria, we will involve not only local commissioners but health and social care providers, patients and organisations from the voluntary sector. Based on this understanding, we aim at developing an accessible and truly useful tool, that explicitly incorporates all relevant criteria.
Working closely with decision-makers and other stakeholders improves the chances of active adoption of this tool. Furthermore, stakeholder participation increases the legitimacy and accountability of the prioritisation process.
Ultimately, and more importantly, the priority-setting tool that will be developed in will help local policy-makers to provide greater access to effective care and higher quality of care to patients.
- Understand the local commissioning decision context in England with a focus on integrated care interventions.
- Choose the most suitable priority-setting method to local decision-making in England.
- Identify all relevant assessment criteria for commissioners, patients and other stakeholders.
- Assess the relative preference of assessment criteria assigned by different stakeholders.
- Develop an accessible and transparent decision tool that commissioners can easily use to systematically assess and monitor integrated care services, based on their performance on multiple relevant criteria.
- Development of a decision tool to support commissioners to easily assess and monitor integrated care services.
- Commissioners can allocate resources using a structured approach. This will result in costs savings but also impact on patient experience and outcomes.