The children and young people’s health partnership (cyphp) evelina london model of care

摘要

Introduction : Chronic, non-communicable disease, accounts for the vast majority of all disability adjusted life years lost (DALYS), among children and young people in high income countries. Our current model of hospital‐centred paediatric care was developed to deliver acute inpatient and high intensity specialist services rather than high quality care for children and young people (CYP) with long-term conditions. Short description of practice change implemented : The CYPHP Evelina London model is an innovative approach to reshaping everyday healthcare services, expanding on the principles of integrated care. The model was developed with key stakeholders including CYP, carers, front line practitioners and health service commissioners. It includes the guiding principles of integration across primary and secondary care (vertical integration); caring for the whole person by integrating care across physical, social and mental health; ensuring age appropriate care; and ensuring early intervention and prevention services are developed. Aim and theory of change : The model aims to improve child health, healthcare quality, and optimise health service use, focusing care closer to home. The theoretical framework for the CYPHP Evelina London Model has been developed using the WHO health systems building blocks and highlights system change in terms of leadership, finance, workforce, technology, analysis and transformation of key services. Targeted population and stakeholders : The model offers universal services to all children alongside specific services for children with asthma, epilepsy, constipation and eczema, chosen as exemplars conditions of chronic and/or common paediatric conditions. Timeline : The new service is being evaluated using a cluster randomised controlled trial involving 90,000 children. Highlights : The model includes: - Decision support tools for GPs. - Paediatric hotline enabling rapid communication between GPs and paediatricians. - Minor illness and wellness support and services for the most common problems and illnesses. - Self-management support, health promotion, and health education material. - Tailored multidisciplinary clinical service for children with asthma, eczema, epilepsy and constipation. - Integrated child health clinics jointly run by GPs and local Paediatricians Sustainability : The CYPHP Evelina London model of care was developed in partnership with local decision makers and is accountable to them. Financial sustainability is a core requirement of the model, and transition to business as usual is ongoing as evaluation results become available. Transferability : The CYPHP Evelina London model serves a diverse urban population, and our robust evaluation using a cluster randomised controlled trial design ensures generalizable results. Conclusions : Health Team operated in different ways to traditional models of care to meet not only the physical, but mental and social needs of patients. Initial results show high levels of unmet need for treated patients, increased reach of the intervention and decrease in health service use for children with tracer conditions. Discussions : CYPHP is the largest health systems transformation programme currently being delivered for children in the UK. Barriers and facilitators to the development and roll out of CYPHP will be discussed. Lessons learned : Facilitators for successful rollout of the programme include buy in from commissioning partners and GP champions.