Health systems around the world are aiming to improve the integration of health and social care services to deliver better care for patients. The evidence base is weak, however, and it is unclear if integrated care programmes actually lead to better integration of services and indeed whether greater integration is associated with improved outcomes. Therefore, using outpatient and inpatient Hospital Episode Statistics data from 500 general practices during 2013/14- 2017/18 in ten intervened and ten comparison sites in England, we applied a linear structural equation modelling and difference-in-differences approach within mediation analysis to examine if the integrated primary and acute care systems (PACS) model led to greater integration of care and whether this integration is causally associated with admissions for ambulatory care sensitive conditions. We measured integration using the concentration index of outpatient referrals at the GP practice level. We found that, while PACS increased integration of primary and secondary care, this type of integration did not mediate a decrease in unplanned hospital admissions. This analysis emphasises the need to better understand the hypothesised causal impact of integration on health outcomes.
Authors: David G. Lugo-Palacios (a,b), Jonathan M. Clarke (b,c), Søren Rud Kristensen (b,d)
a Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine
b Centre for Health Policy, Institute of Global Health Innovation, Imperial College London
c EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London
d University of Southern Denmark
Speaker: David Lugo, London School of Hygiene and Tropical Medicine, Link bio
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