The following list of measures was used in one or more of the surveys (Table 3).
l Baseline assessment included sociodemographic questions from the General Practice Patient Survey,56 including sex, age, work situation and qualifications; ethnicity using 17 2011 Census categories;57 a single-item health literacy measure;58a measure of the number and impact of long-term conditions;59 and use of local community assets.60
l The Patient Assessment of Chronic Illness Care (PACIC),61which includes items in five subscales (patient activation, delivery system design and decision support, goal-setting, problem-solving, and co-ordination); we used the short 11-item version.62
l The Patient Activation Measure (PAM) of patient knowledge, skills and confidence in self-management for long-term conditions;54,63we used the short 13-item version.64
l The Summary of Diabetes Self-Care Activities (SDSCA) measure assesses the number of days per week on which respondents engage in healthy and unhealthy behaviours.65
l The Multimorbidity Illness Perceptions Scale (MULTIPleS) assesses patient experience of managing multimorbidity;66we used 16 items from the MULTIPleS.
l The Quality, Innovation, Productivity and Prevention (QIPP) measure of personalised long-term condition care.67
l The ENRICHD Social Support Instrument (ESSI).68
l The EuroQol-5 Dimensions (EQ-5D) measure of health-related quality of life;69we used the new EuroQol-5 Dimensions, five-level version (EQ-5D-5L).70
l The Mental Health Inventory–5 (MHI-5) is a five-item scale that measures general mental health.71 l The ICEpop CAPability measure for Older people (ICECAP-O) index of capability measures quality of life
for people aged≥65 years in terms of attachment, security, role, enjoyment and control.72
l The World Health Organization Quality of Life-BREF (WHOQOL-BREF) 26-item measure of global quality of life across four domains (physical health, psychological health, social relationships and environmental), as well as a single-item scale.73
l Health-care utilisation, based on our previous studies;74continuity of care and care planning from the General Practice Patient Survey;56and patient experience of safety from the ICPs evaluation.
l We also used single-item measures assessing other issues, including items assessing issues of interest to stakeholders (e.g. internet use and accommodation).
We used a short assessment for carers, including EQ-5D, Patient Health Questionnaire-9 items, ICECAP-O and the Modified Caregiver Strain Index.75Carer data are presented inAppendix 1.
TABLE 3 Measures used in the cohort
Baseline
Follow-up time point
6 months 12 months 18 months
l Sociodemographic information
l Ethnicity
l Health literacy measure
l ENRICHD l Bayliss Long-Term Condition Scale l Community groups l PACIC l PAM l MHI-5 l SDSCA l MULTIPleS l EQ-5D l WHOQOL-BREF l Health-care utilisation l ICECAP-O l LTC6 l E-mail communication l Community groups l PAM l MHI-5 l EQ-5D l WHOQOL-BREF l Health-care utilisation l Community groups l PAM l MHI-5 l EQ-5D l WHOQOL-BREF l Health-care utilisation l Accommodation questions l Internet use l Community groups l PAM l MHI-5 l SDSCA l EQ-5D l WHOQOL-BREF l Health-care utilisation l LTC6 LTC, long-term condition.
Chapter 5
Methods of implementation 1
I
mplementation 1 was designed to address the following research question:How do key stakeholders (commissioners, strategic partners) view the SICP, what do they expect from it and how is it aligned with their objectives and incentives?
The specific objectives were to explore and understand:
l how commissioners view the programme, what they expect from it and how it is seen in terms of their performance objectives
l how the programme is viewed by strategic partners such as the local authority and how it is sustained under financial pressure
l how the programme affects the work of the two foundation trusts, in particular how the integrated community and acute provider adapts to reductions in inpatient activity
l how the programme affects primary care, in particular general practice
l the extent to which the financial incentives (explicit and implicit) in the local health and social care system are aligned with the ambitions of the programme.
A qualitative approach was adopted to understand how the SICP was developed and how organisations were working together to transform care. Fieldwork took place from November 2014 to September 2016. Data collection included approximately 56 hours of non-participant observations of SICP programme meetings. A researcher attended meetings, including the Alliance Board, Study Steering Group and MDG meetings.
In addition, 28 interviews were carried out with professionals working across the four key stakeholder organisations associated with the SICP. Initially, 22 interviews were carried out in late 2014/early 2015 and six follow-up interviews were carried out with key stakeholders in 2016 to see how the SICP had developed, the factors that influenced the SICP and the relationships across the four key stakeholder organisations (Table 4). Documents, including operational plans and business cases, were collected from the SICP and relevant meetings to provide context.
TABLE 4 Data collection in implementation 1
Data collection method
Number of
interviews Further information
Interviews 28 in total (22 plus six follow-up interviews)
l 6 with foundation trust staff (all senior managers or programme managers)
l 6 with CCG staff (GPs and senior managers)
l 6 with council staff (including senior management, management and public health)
l 1 with a GP provider organisation
l 3 with mental health trust staff (all senior managers) Observations 19 (around 56 hours) Observations included:
l engagement events
l MDGs
l Study Steering Group
l Alliance Board
l Finance Group
l Advisory Board
l Integrated Health and Commissioning Joint Committee
The data from interviews and observations were coded in the same way and analysis of the data was facilitated by the computerised data analysis package NVivo version 10 (QSR International, Warrington, UK). Initial coding was carried out using a priori codes derived from our existing understanding of the issues associated with commissioning complex programmes. These were supplemented by inductive coding arising from the data. Analytical memos were written and discussed to develop a collective understanding of the issues represented in the data.
Findings relating to the commissioning of the programme were shared with the wider research team and further explored in interviews with those responsible for the implementation of the project.
Chapter 6
Methods of implementation 2
I
mplementation 2 was designed to address the following research questions. Multidisciplinary groups:l What are the characteristics and composition of the groups?
l How do the groups function as teams and in collaboration with other providers? l How well do the groups achieve fidelity to the original SICP model?
l What are the key barriers to and facilitators of effective functioning and outcomes? l How is the work of the groups experienced by patients and carers?
Integrated contact centre:
l What services are provided by the centre and which staff provide those services? l What is uptake and usage of the ICC services?
l What are the key barriers to, and facilitators of, effective functioning and outcomes? l How are ICC services experienced by patients and carers?