Rapid evaluation for health and social care innovations: challenges for “quick wins” using interrupted time series

摘要

BackgroundThe NHS 5 Year Forward View [1] set out the strategic plan for the NHS and included within it a number of challenges to the models of care required to meet changing patient and carer needs. It established 50 vanguard sites to take the lead on 5 new models of care with a key facet being improved integration within the system of care delivery to improve outcomes, and ensuring care and treatment were delivered in the most appropriate and efficient setting. One of the models identified was the Enhanced Health in Care Homes (EHCH). Against the backdrop of the need to break down barriers in care provision, 1 in 7 people over 85 living in a long term care setting, and spending increasingly significantly with age, 6 EHCH vanguard sites were set up nationally to challenge ways of working and improve integration and outcomes. Key outcomes include helping frail and older people to stay healthy and independent and reduce unnecessary hospital admissions, and reviewing models of working and contracting arrangements [2].The Gateshead Enhanced Health in Care Homes new model of care was selected to be one of these vanguards and was launched in March 2015. The vanguard’s purpose was to increase collaborative working and establish partnerships between health and care providers to improve the health and wellbeing of residents and thereby reduce pressure on primary, secondary and social care services. The vanguard consisted of three key features: Link GP Practices, Older Person Specialist Nurses (OPSN), and Multi-Disciplinary Teams (MDTs). The link GP Practices strand of the vanguard consists of signing up residents of a care home to the same GP practice (usually the closest geographically). Older Person Specialist Nurses were also assigned to care homes in both localities in order to support care home staff in delivering care. Furthermore, each care home had a Multi-Disciplinary Team (MD) which consisted of key healthcare professionals such as; geriatric consultants, link GPs, and specialist nurses.Evaluation of these vanguards was at the heart of the programme: enabling the widespread adoption of new models of care that improve the health and wellbeing of patients; the quality and equality of care that patients receive; and the efficiency of the overall system [3]. Indeed, there was an emphasis as part of the evaluation strategy that findings should be shared rapidly among the vanguards and spread throughout the NHS. This echoes a relatively recent phenomenon of a rapid cycle of evaluation in health services research.Rapid evaluation as a strategy for evaluation gained traction in 2018 with the creation of two National Institute for Health Research (NIHR) funded research centres, the Birmingham RAND and Cambridge Evaluation (BRACE), and the Rapid Service Evaluation Team (‘RSET’) these were created to conduct rapid evaluations of promising new services and innovations in healthcare over a five-year programme.A local evaluation for the Gateshead EHCH vanguard was commissioned to quantitatively evaluate the impact of the vanguard in terms of effect and value for money. This evaluation was conducted during the first 2 years of the roll out of the vanguard and was part of the evaluation strategy for rapid evaluation and learning across the health and social care economy. In addition to this initial evaluation, a further evaluation was conducted utilising a much larger data set with more pre and post intervention data points. The aim of this paper is to present and compare the findings of the two evaluations and to investigate the implications of the use of rapid evaluations using interrupted time series (ITS) methods.