Approach and methods

IAU evaluations of three MDT initiatives

The IAU evaluated the effect of three MDT initiatives in England (Box 2) by comparing the outcomes of patients receiving care or support from MDTs to a comparison group. This group consisted of patients with similar characteristics to those enrolled in the MDT (eg age, gender, ethnicity, level of deprivation, long-term conditions, frailty and historic hospital use).

Characteristics were identified from pseudonymised patient-level hospital records. As one of the aims of the new care model vanguard programmes was to reduce unnecessary emergency hospital use, we predominately investigated the effect of MDTs on A&E attendances and emergency hospital admissions. As we used routine health data for our analyses, we were not able to analyse the effect on other outcomes, such as patient satisfaction or quality of life. Further details on the methods can be found in the original reports and in the Appendix.,

Box 2: The MDTs and integrated care programmes evaluated

The IAU evaluated three MDT initiatives in England, implemented as part of a wider set of integrated care initiatives introduced within the New Care Models vanguard programme in 2015 or 2016. These sites were chosen based on strategic relevance, local interest and feasibility at the time.

The evaluations of these MDTs covered periods up to 2018. Each of the programmes will have evolved since then, so the evaluation findings may not reflect their current impact – though the MDTs we evaluated are likely to share similarities with community-based MDTs currently being implemented.

The MDT initiatives were:

  • Integrated care teams (ICTs) in North East Hampshire and Farnham (NEHF), study period 2015–2017.
  • Extensive care services (ECS) in Fylde Coast, study period 2015–2018.
  • Enhanced primary care (EPC) in Fylde Coast, study period 2016–2018.

All three programmes were based in the community and targeted patients at higher risk of emergency hospital use. The MDTs consisted of medical and non-medical staff that met regularly (typically once a week) to plan and coordinate services for patients referred to their services. Each programme consisted of several MDTs that served a local area of around 30,000 to 50,000 individuals – similar in size to PCNs.

The MDTs were run in a similar way but with some notable differences between the three programmes. ECS replaced patients’ usual GP, taking over full clinical responsibility for their patients for the period of enrolment, whereas the other two models provided additional support to GP care (eg care planning or self-management advice).

There were also differences in referral criteria and how patients were identified for referral to MDTs. ECS and EPC used risk stratification models, while ICT referrals in NEHF were predominately identified by clinical judgement.

All three MDT programmes were core components of new care models vanguard programmes – wider integrated care initiatives starting in 2015, which encompassed a range of interventions. An additional programme evaluated by the IAU – the Integrated Care Transformation programme in Mid-Nottinghamshire – also included MDTs as a core component. This programme launched in 2013 and received vanguard status in 2015.One of the aims of the new care model vanguard programmes was to reduce unnecessary emergency hospital use. The four programmes covered areas of varied demographics, rurality and deprivation. Vanguard services differed between areas – for instance, interventions in NEHF included a rapid home response service and out-of-hours support for people having or nearing a mental health crisis. Fylde Coast introduced support for frequent 999 callers and Mid-Nottinghamshire introduced proactive care planning for those using A&E services most frequently.

Further details on the MDTs, the vanguard programmes and the local context can be found in the original reports.,,

IAU evaluations on the longer term impact of integrated care programmes with MDTs

Implementing and embedding new models of integrated care is complex and it can take time to deliver improvements. The IAU also evaluated the broader integrated care programmes that implemented the three MDTs over a longer time period. The evaluations covered the areas of Fylde and Wyre, Blackpool (both of which implemented EPC and ECS under the overarching Fylde Coast vanguard but were analysed separately as they differed in demographics, rurality and deprivation) and NEHF. We also evaluated the Integrated Care Transformation programme in Mid-Nottinghamshire, which included MDTs as one of its main initiatives (Box 2).

For each of the analyses, we evaluated the effect of the integrated care programme by comparing emergency hospital use against a comparison area for a period ranging from 4.5 to 6 years. These comparison areas were constructed from other comparable areas in England (in terms of factors such as population size, age distribution and deprivation levels) in such a way as to have similar outcomes to the evaluated areas in the 2 years prior to the start of the programme. We looked at the effect on the whole populations aged 18 years and older and 65 years and older, respectively. Further details on the methods can be found in the original reports.,,

Wider evidence of MDT impacts

To put the findings from our IAU studies in the context of the broader evidence, we conducted a rapid review of relevant systematic reviews of quantitative evidence on the impacts of community-based MDTs for adults with complex health and care needs – for example, with multiple long-term health conditions – or people living with frailty or at high risk of hospitalisation. We focused on reviews that included at least one study of MDTs from the UK alongside evidence from other high-income countries, and where the MDTs included at least one health care professional, such as a GP. More detail about the studies is included in Box 3. See the Appendix for further detail on the methods.

Box 3: The studies we reviewed

Our review included eight studies – six systematic reviews,,,,, and two umbrella reviews (reviews of systematic reviews) of the literature, (see Appendix, Table 2). Two included meta-analysis (pooling data from several studies to understand overall effects)., The reviews focused on studies of MDTs from high-income countries and all included at least one study from the UK. The quality of evidence was weak.

The reviews studied MDTs in a mix of ways. Some focused on interventions that make use of MDTs, such as community mental health teams for older people and intensive primary care support. Others looked at MDTs alongside a mix of similar interventions involving care coordination. The MDTs studied typically formed part of more complex integrated care initiatives – for instance, combined with case management and wider organisational changes – making their impacts hard to measure and interpret.

The reviews focused on a range of care settings, staff groups and populations. Care settings typically included primary care, residential or nursing accommodation, patients’ homes, or boundary-spanning interventions across several settings. Staff groups and the composition of MDTs varied depending on the context and focus, but included a mix of staff from health and social care settings.

Most reviews focused on outcomes for specific groups including older people,, patients with chronic conditions,,, and patients with complex needs. Two focused on outcomes for a mix of population groups., The majority of reviews reported that older people, typically those with complex needs, were the most common target group for MDTs among the primary studies they reviewed.

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