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Theme: Person-Centred Care
Read a BITE sized summary of this project.
There is now widespread recognition that the care provided by the NHS, social care and other associated community services should strive to be more person-centred i.e. both centred around and responsive to the needs of the individual. For this to be achieved effectively, services need to be better co-ordinated and, in some circumstances, integrated fully. Person-Centred Coordinated Care (PCCC) is perceived as a way of achieving better outcomes for patients and improved efficiency for health and care economies. We have defined person-centred and coordinated care as:
‘Care that is guided by and organised effectively around the needs and preferences of the individual’
This programme combines the following activities in order to ensure learning contributes both to local service improvement and international knowledge:
PCCC is now a priority for all stakeholders (i.e. patients, carers, staff, commissioners, and policy makers). Our collaboration with the South West Academic Health Science Network (SW AHSN) aimed to develop theory, innovation and a consistent evaluation framework for PCCC.
This began with a joint scoping project in 2014 to grapple with the complex conceptual challenges associated with integrated care. Through a process of critical examination of policy material and key literature we have moved away from the notion of ‘Integrated Care’, and have brought two key concepts together that represent key concerns and experiences of importance from the perspective of the individual receiving care: person-centred and coordinated care.
Anchoring our work in the perspective of the individual has enabled us to move towards a testable theoretical model and a shared understanding of the key constituent components to test for the delivery of PCCC. This work led to the development of:
We have since been commissioned to evaluate the following programmes:
The Newton Abbot Complex Care Hub, The Torquay Children and Families Hub (SWIFT), Torbay Integrated Care Organisation (ICO), Somerset Practice Quality Scheme (SPQS), Somerset Test and Learn Pilots, Integrated Care Exeter (ICE).
For these projects we are conducting mixed methods community co-creation action evaluations, with exploration of key implementation processes and issues. A core feature of the evaluations will be the collection of three levels of data on a subset of the wider cohort of patients involving qualitative interviews and observations with staff and community members; structured questionnaires on the experiences of care and mental health; and system-wide metrics service use data.
Engagement activities are key to the evaluations. Structured questionnaires on the experiences of care delivery (our P3CEQ) and our organisational change tool (P3C-OCT) to monitor coordinated activities will be completed by core staff where possible. We also collected service use data, tracing this across health and social care by data linkage processes. This will build longer term internal evaluation capacity with external (research team) resourcing for qualitative input and data synthesis.
Analysis focused both on investigation of the core components of the specific intervention model as well as seeking to understand implementation and barriers and facilitators to success. Feedback of results will be rapid contributing both to improve interventions/models of care and to more summative evaluation.
Development of evaluation framework including:
Working with SW ASHN, the PenCLAHRC team performed a comprehensive mixed-methods evaluation of the Somerset Practice Quality Scheme (SPQS) pilot. SPQS arose because GPs, the Clinical Commissioning Group (CCG) and the Local Medical Committee (LMC) felt that the Quality and Outcomes Framework (QOF) was not incentivising the highest value clinical behaviour. They felt that removing the link between the incentives and clinical activity of QOF would improve the provision of Person-Centred Coordinated Care (P3C), so the SPQS aimed to find out if this was the case. The project findings have been shared with the clinical commissioning group (CCG), NHS England, and the participating GP surgeries. Find out more in the project report: An evaluation of the Somerset Practice Quality Scheme (SPQS).
We have developed the first free and openly-available comprehensive data resource for international measures relating to patient experience and person centred care. This Measures for Person Centred Coordinated Care information gateway tool provides a ‘one-stop’ website for commissioners, health managers, researchers and others.
Other resources: If you would like to use any of our other measures please register and complete our user agreement form. We are happy for these to be used for research and service development and would welcome the opportunity to discuss this with you further:
Britten N, Moore L, Lydahl D, Naldemirci O, Elam M, Wolf A. Elaboration of the Gothenburg Model of Person-Centred Care. Health Expectations 2016.
Sheaff R, Halliday J, Ovretveit J, Byng R, Exworthy M, Peckham S, Asthana S. Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination. Health Services and Delivery Research 2015; 3(35)
Heaton J, Britten N, Krska J, Reeve J. Person-centred medicines optimisation policy in England: An agenda for research on polypharmacy. Primary Health Care Research and Development 2016; 18(1)
Naldemirci O, Lydahl D, Britten N, Elam M, Moore L, Wolf A. Tenacious assumptions of person-centred care? Exploring tensions and variations in practice. Health 2016
Moore L, Britten N, Lydahl D, Naldemirci O, Elam M, Wolf A. Barriers and facilitators to the implementation of personcentred care in different healthcare contexts. Scandinavian Journal of Caring Science 2016
Sheaff R, Halliday J, Byng R, Ovretveit J, Exworthy M, Peckham S, Asthana S. Bridging the discursive gap between lay and medical discourse in care coordination. Sociology of Health and Illness 2017
Dr Lynne Callaghan, Kelly Blockley, Donna Chard, Deborah Shenton, Dr Inocencio Maramba, Louise Witts, Jane Horrell, Richard Blackwell, Tracey Humphries, Thava Priya Sugavanam