Building a portfolio of research findings for use by healthcare managers and decision-makers using

integrated care as a sample theme

NIHR Health Services and Delivery Research programme

Matt Westmore, Director of NETSCC

Steph Garfield-Birkbeck, Assistant Director

Donna White, Research Fellow

  To have an IMPACT

What research do managers

need to deliver good services?

National Institute for Health Research

£1bn (€1.2bn)/yearApplied health

research system for the

UK’s NHS

Health Services and Delivery Research

programme

C£16m (€19.8m)Focus on quality and 

effectiveness of healthcare systems 

Who are we – what do we do?

Therefore we assess research topics for need BEFORE scientific merit

What do we mean by need?

Ability to benefit – mediated through service organisation and delivery

Stevens, A. and Raftery, J. (1994) Health Care Needs Assessment: The Epidemiologically Based Needs Assessment Reviews. Oxford: Radcliffe Medical

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Identifying need (the right research questions)

Collect suggestions for research throughout the year from individuals, patients, public, professionals, literature, societies and groups

Annual stakeholder engagement exercise involving senior managers, service providers and some academics

Further selection and prioritisation by a standing panel made up of external (to us) independent NHS managers, clinicians, researchers

Literature and evidence summary written and reviewed by experts

Call for research advertised. Final list of approved topics forms the research agenda for the HS&DR programme

Engaging with the research-using community; meeting its needs

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What do we mean by integration?

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Specific calls for research relevant to integrated care

Integrated care portfolio: April 2009 – Sept 2011

Call title Funding

Evaluating Innovations in Integrating Health £2m (€2.5m)

Research on Primary Care and Community care and Community Health Services £3m (€3.7)

NHS Care Homes £3m (€3.7)

Patient safety in healthcare organisations £2m (€2.5m)

Expedited evidence synthesis to support decision-making by managers and leaders in the NHS £50k-80k (~€80k) per project

Total portfolio (specific calls and open calls)

Projects funded 42

Funding committed

£14.5m (€18m) out of £35m (€43m) across all calls

Mean cost £350k (€430k)

Mean duration 31 months

Research type

Secondary only 9%

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Completed research In progress

‘Self management support among older adults’, Ms Suzanne Parsons, April 2010

•experiences and expectations

‘Self care and case management in long term conditions’, Professor David Challis, April 2008

•Map current provision•integrated care initiatives as determinants for entry to and exit from case management

‘Assessing outcomes of integrated care for people with long term conditions’, Professor Gillian Parker, Uni’ of York

•How health and social care services have been integrated?•What outcomes do people with long term conditions want?

‘Analysis of virtual wards’, Dr Geraint Lewis, Nuffield Trust

•Do 'Virtual Wards' lead to changes in use of care?•What are the costs and savings of Virtual Wards?

All have project webpages with descriptions, protocol and final reports 7

Further information

hsdrinfo@southampton.ac.uk

www.nihr.ac.uk

www.netscc.ac.uk/hsdr/

@officalNIHR - #NIHR

Paper submitted to Journal of Integrated Care

This presentation presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Mensajes para llevar a casa (take home messages)

• NIHR Health Service and Delivery Programme is focussed on evidence for UK NHS healthcare managers and decision-makers.

• We commission research based on the need of the NHS in addition to scientific merit

• We have commissioned a significant and balanced portfolio of research relevant to integrated care

• All will publish freely available comprehensive final reports on our website

NIHR stand in the

exhibition!

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ADDITIONAL SLIDES

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Example completed Research

‘Self management support among older adults’,

Ms Suzanne Parsons, Picker Institute Europe, April 2010

‘Self care and case management in long term conditions’,

Professor David Challis, University of Manchester, April 2008

Map current provision of NHS case management services.

Look at integrated care initiatives as determinants for entry to and exit from case management services

Investigate the self management experiences and expectations of older people

Compare these experiences and expectations against the availability of support

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‘Assessing outcomes of integrated care for people with long term conditions’,

Professor Gillian Parker, Uni’ of York

Example research under way

How health and social care services have been integrated?

What outcomes do people with long term conditions want?

Work with services to introduce the outcomes required by people with long term conditions

‘Analysis of virtual wards’,

Dr Geraint Lewis, Nuffield Trust

Do 'Virtual Wards' lead to changes in use of care?

What are the costs and savings of Virtual Wards?

Develop an interactive cost model for optimal configuration of Virtual Wards

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What do we mean by impact?

Need

Research

Outputs(e.g.

papers)

Outcomes(e.g.

guidance)

12Therefore we assess research topics for need BEFORE scientific merit

Our theory of change

Environment level: The research pathway

System level: Adding value to research – avoidable waste

Based on Chalmers and Glasziou. Avoidable waste in the production and reporting of research evidence. Lancet (2009) vol. 374 (9683) pp. 86-9

Impact

Impact

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Our ‘needs-led approach’

Needs-led, science-added evidence production

Patients, public and the

NHS at the heart of the funding process and funded projects

= more important, higher quality, less waste = higher impact

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The NIHR Health Research System

Research

Research Projects & Programmes

Research Governance

Systems

Research Information

Systems

Patients&

Public

Universities

Investigators &Senior

InvestigatorsAssociatesTrainees

Research Schools

NHS TrustsClinical Research Networks

Clinical Research Facilities, Centres

& Units

Infrastructure

Systems

Faculty

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NETSCC: Established: 2008

Public Health Research

Established: 2008

Health Technology Assessment

Established: 1993

Health Services and Delivery Research

Established 2012 by merging HSR and SDO

Efficacy and Mechanism EvaluationResearcher-ledFunded by the MRC Managed by NIHRCommissionedFunded and managedby NIHREstablished: 2008 and 2011

Systematic Reviewsprogramme

Inc. UK Cochrane Centre Cochrane Review GroupsCRD

NETS (Evaluation, Trials and Studies programmes)

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National Institute for Health Research•£1bn (€1.2bn)/year applied health research system

•UK Department of Health (with contributions from devolved administrations)

Health Services and Deliver Research: •One of the NIHR’s funding programmes

•Focussed on service delivery, organisation, knowledge transfer, quality, effectiveness and accessibility of the UK NHS

•For healthcare managers and decision-makers.  

Our approach: Adding value to research – reducing avoidable waste

Based on Chalmers and Glasziou. Avoidable waste in the production and reporting of research evidence. Lancet (2009) vol. 374 (9683) pp. 86-9

Impact

Research funding context

Ask the right questions

Answer them the right way 17

 

Impacte.g. better services

Ask the right questions

Answer them the right way

What research do managers need to

deliver good services?

National Institute for Health Research

£1bn (€1.2bn)/yearApplied health

research system for the

UK’s NHS

Health Services and Delivery Research

programme

C£16m (€19.8m)Focus on quality and 

effectiveness of healthcare systems 

Who are we – what do we do?

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Self-care and Case Managementin Long-term ConditionsProfessor David Challis, University of Manchester

To map current provision of NHS case management services in primary care for people with long-term conditions

To classify by observable features, different initiatives of integrated care both between primary and secondary care, and between health and social care

To identify the extent and nature of self-care initiatives and to look at the role of these initiatives as determinantsfor entry to and exit from case management services

Final report published in April 2008

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Self Management Support among Older AdultsMs Suzanne Parsons, Picker Institute Europe

To investigate the self management experiences and expectations of older people

To compare these against the availability of support from locally based services and community resources

In four geographical areas of England

Final report published in April 2010

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Analysis of Virtual WardsDr Geraint Lewis, Nuffield Trust

To assess the extent to which integrating health and social care services by means of 'Virtual Wards'(VW) leads to changes in the use of emergency hospital care and social care

To establish the costs and savings of Virtual Wards from the perspectives of society, the NHS and Local Government

To develop an index for determining the optimal case load for multi-disciplinary case management that accounts for the case-load versus quality of care trade-off

To develop an interactive cost model where users input local variables and the model advises the user as to the optimal configuration of Virtual Wards locally, taking into account case-mix

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Assessing outcomes of integrated care for people with long term conditionsProfessor Gillian Parker, University of York

To explore how health and social care services have been integrated in four geographical areas in England

To explore with people with long term conditions, what outcomes are wanted from integrated health and social care services

To design a checklist based on the outcomes required by people with long term conditions for services to use

To see how services are using the checklist, whether services change ways of working with people with long term conditions, whether the checklist helps people get what they need

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Identifying the right research questions

Annual stakeholder engagement exercise•Collect suggestions for research throughout the year

•Present to a wide participatory workshop made up of NHS managers, decision-makers, organisation representatives, researchers

•Hone down the list of some 50 topics to 20

•Further selection by the prioritisation panel made up of NHS managers, clinicians, researchers

•Final list of topics forms the research agenda for the HS&DR programme

Engaging with the research-using community; meeting its needs

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Researcher-ledResearcher-led

Types of Research

Primary researchEvidence synthesis

Who defines the question?

Researcher

Frequency Per year

3 calls per year

Primary researchEvidence synthesis

HS&DR programme

3 calls per year(6+ topics)

CommissionedCommissioned

What happens in practice: work streams

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• Health need• Expressed need• Sustained interest• Capacity to generate new knowledge• Actionable findings and prospects for change

Answering them the right way: assessing the Scientific quality and appropriateness

•Quality and scientific merit

•Links with knowledge users and where appropriate

•Value for money

•See Tara Lamont presentation…

Two stage assessment process

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