Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Health Research Policy and Systems
Published in: Health Research Policy and Systems 1/2017

Open Access 01-12-2017 | Opinion

Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care

Authors: Helen M. Lloyd, Mark Pearson, Rod Sheaff, Sheena Asthana, Hannah Wheat, Thava Priya Sugavanam, Nicky Britten, Jose Valderas, Michael Bainbridge, Louise Witts, Debra Westlake, Jane Horrell, Richard Byng

Published in: Health Research Policy and Systems | Issue 1/2017

Login to get access

Abstract

Background

Fragmented care results in poor outcomes for individuals with complexity of need. Person-centred coordinated care (P3C) is perceived to be a potential solution, but an absence of accessible evidence and the lack of a scalable ‘blue print’ mean that services are ‘experimenting’ with new models of care with little guidance and support. This paper presents an approach to the implementation of P3C using collaborative action, providing examples of early developments across this programme of work, the core aim of which is to accelerate the spread and adoption of P3C in United Kingdom primary care settings.

Methods

Two centrally funded United Kingdom organisations (South West Collaboration for Leadership in Applied Health Research and Care and South West Academic Health Science Network) are leading this initiative to narrow the gap between research and practice in this urgent area of improvement through a programme of service change, evaluation and research. Multi-stakeholder engagement and co-design are core to the approach. A whole system measurement framework combines outcomes of importance to patients, practitioners and health organisations. Iterative and multi-level feedback helps to shape service change while collecting practice-based data to generate implementation knowledge for the delivery of P3C. The role of the research team is proving vital to support informed change and challenge organisational practice. The bidirectional flow of knowledge and evidence relies on the transitional positioning of researchers and research organisations.

Results

Extensive engagement and embedded researchers have led to strong collaborations across the region. Practice is beginning to show signs of change and data flow and exchange is taking place. However, working in this way is not without its challenges; progress has been slow in the development of a linked data set to allow us to assess impact innovations from a cost perspective. Trust is vital, takes time to establish and is dependent on the exchange of services and interactions. If collaborative action can foster P3C it will require sustained commitment from both research and practice. This approach is a radical departure from how policy, research and practice traditionally work, but one that we argue is now necessary to deal with the most complex health and social problems.
Literature
1.
Ryan J, Abrams MK, Doty MM, Shah T, Schneider EC. How high-need patients experience health care in the United States: findings from the 2016 Commonwealth Fund Survey of High-Need Patients. New York, NY: The Commonwealth Fund; 2016.
2.
Curry N, Goodwin N, Naylor C, Robinson R. Practice based commissioning. Reinvigorate, replace or abandon? London: Kings Fund; 2008.
3.
Sheaff RHJ, Øvretveit J, Byng R, Exworthy M, Peckham S, et al. Integration and continuity of primary care: polyclinics and alternatives, an organisational analysis. Health Serv Deliv Res. 2015;3:35. doi:10.​3310/​hsdr03350.
4.
5.
Royal College of Physicians. Putting the Pieces Together: Removing the Barriers to Excellent Patient Care. London: Royal College of Physicians; 2015.
6.
Humphries R. Health and social care for older people: progress, problems and priorities. Qual Ageing Older Adults. 2015;16(1):27–31.CrossRef
7.
Schoen C, Osborn R, Squires D, Doty M, Pierson R, Applebaum S. New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health Affairs (Project Hope). 2011;30(12):2437.CrossRef
8.
Oliver D, Foot C, Humphries R. Making our Health and Care Systems Fit for an Ageing Population. London: The Kings Fund; 2014.
9.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.CrossRefPubMed
10.
Goodwin N, Smith J, Davies A, Perry C, Rosen R, Dixon A, et al. Integrated Care for Patients and Populations: Improving Outcomes by Working Together. London: The King’s Fund and the Nuffield Trust; 2012.
11.
Kupeli N, Leavey G, Harrington J, Lord K, King M, Nazareth I, et al. What are the Barriers to Care Integration for those at the Advanced Stages of Dementia Living in Care Homes in the UK? Health Care Professional Perspective. London: Dementia; 2016.
12.
Walsh B, Addington-Hall J, Roberts HC, Nicholls PG, Corner J. Outcomes after unplanned admission to hospital in older people: ill-defined conditions as potential indicators of the frailty trajectory. J Am Geriatr Soc. 2012;60(11):2104–9.PubMed
13.
Kasteridis P, Street A, Dolman M, Gallier L, Hudson K, Martin J, et al. Who would most benefit from improved integrated care? Implementing an analytical strategy in South Somerset. Int J Integr Care. 2015;15:e001.CrossRefPubMedPubMedCentral
14.
Bock J-O, Konig H-H, Brenner H, Haefeli WE, Quinzler R, Matschinger H, et al. Associations of frailty with health care costs – results of the ESTHER cohort study. BMC Health Serv Res. 2016;16:127.CrossRef
15.
Tian Y, Thompson J, Buck D. The cost of falls: exploring the cost of the whole system pathway for older people in a rural community in England. J Integr Care. 2014;22(4):173–65.CrossRef
16.
Sinnott C, Mc Hugh S, Browne J, Bradley C. GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open. 2013;3(9):e003610.CrossRefPubMedPubMedCentral
17.
Baird BC, Charles A, Honeyman M, Maguire D, Das P. Understanding Pressures in General Practice. London: The Kings Fund; 2016.
18.
Ham C. World Class Commissioning: a health policy chimera? J Health Serv Res Policy. 2008;13(2):116–21.CrossRefPubMed
19.
20.
Kane RL. Strategies for improving chronic illness care: some issues for the NHS. Aging Health. 2007;3(3):333–42.CrossRef
21.
Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet. 2008;371(9614):725–35.CrossRefPubMedPubMedCentral
22.
Helen F, Sally H, John F. Interventions in community settings that prevent or delay disablement in later life: an overview of the evidence. Qual Ageing Older Adults. 2012;13(3):212–30.CrossRef
23.
24.
Sheaff R, Halliday J, Ovretveit J, Byng R, Exworthy M, Peckham S, et al. Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination. Health Serv Deliv Res. 2015;3(35):201.CrossRef
25.
Dennis K. All together now: a conceptual exploration of integrated care. Healthcare Quarterly. 2009;13(Sp):6–15.CrossRef
26.
27.
Leutz WN. ‘Five Laws for Integrating Medical and Social Services: Lessons from the United States and the United Kingdom’. Milbank Q. 1999;77(1):77.CrossRefPubMedPubMedCentral
28.
Jarzabkowski P, Sillince JA, Shaw D. Strategic ambiguity as a rhetorical resource for enabling multiple interests. Hum Relations. 2010;63(2):219–48.CrossRef
29.
Matland RE. Synthesizing the implementation literature: the ambiguity-conflict model of policy implementation. J Public Adm Res Theory. 1995;5(2):145–74.
30.
Ring PS, Perry JL. Strategic management in public and private organizations: implications of distinctive contexts and constraints. Acad Manag Rev. 1985;10(2):276–86.
31.
Noel PH, Frueh BC, Larme AC, Pugh JA. Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expect. 2005;8(1):54–63.CrossRefPubMedPubMedCentral
32.
Duguay C, Gallagher F, Fortin M. The experience of adults with multimorbidity: a qualitative study. J Comorbidity. 2014;4:11–21.CrossRef
33.
Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;350:h176.CrossRefPubMed
34.
Mercer SW, Gunn J, Bower P, Wyke S, Guthrie B. Managing patients with mental and physical multimorbidity. BMJ. 2012;345:e5559.CrossRefPubMed
35.
Loffler C, Kaduszkiewicz H, Stolzenbach CO, Streich W, Fuchs A, van den Bussche H, et al. Coping with multimorbidity in old age--a qualitative study. BMC Fam Pract. 2012;13:45.CrossRefPubMedPubMedCentral
36.
Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012;345:e5205.CrossRefPubMedPubMedCentral
37.
France EF, Wyke S, Gunn JM, Mair FS, McLean G, Mercer SW. Multimorbidity in primary care: a systematic review of prospective cohort studies. Br J Gen Pract. 2012;62(597):e297–307.CrossRefPubMedPubMedCentral
38.
39.
40.
Gravelle H, Dusheiko M, Sheaff R, Sargent P, Boaden R, Pickard S, et al. Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ. 2007;334(7583):31.CrossRefPubMed
41.
42.
Gilburt H. Supporting Integration through New Roles and Working Across Boundaries. London: Kings Fund; 2016.
43.
Auerbach AD, Landefeld CS, Shojania KG. The tension between needing to improve care and knowing how to do it. N Engl J Med. 2007;357(6):608–13.CrossRefPubMed
44.
Pawson R, Tilley N. Realistic Evaluation. London: SAGE Publications; 1997.
45.
Rycroft-Malone J, Wilkinson J, Burton CR, Harvey G, McCormack B, Graham I, et al. Collaborative action around implementation in Collaborations for Leadership in Applied Health Research and Care: towards a programme theory. J Health Serv Res Policy. 2013;18(3 Suppl):13–26.CrossRefPubMed
46.
Glasgow RE, Green LW, Taylor MV, Stange KC. An evidence integration triangle for aligning science with policy and practice. Am J Prev Med. 2012;42(6):646–54.CrossRefPubMedPubMedCentral
47.
48.
49.
50.
Lloyd H, Sugavanam, T, Wheat H, Horrell J, Close J. A Guide for Commissioners on the Use Metrics for Person Centred Cooridnated Care for People with Long Term Conditions, Multiple Long Term Conditions and Those at the End of their Life. London: National Health Service England; 2017.
51.
Sugavanam T, Byng R, Horrell J, Fosh B, Close J, Lloyd H. Co-designing a generic measure to probe person centred coordinated care from the perspective of the patient: the development of the P3CEQ. J Patient Experience. 2017. Ahead of print.
52.
Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Fam Pract. 2008;25 Suppl 1:i20–4.CrossRefPubMed
53.
Dow B. Development and initial testing of the Person-Centred Health Care for Older Adults Survey. Int Psychogeriatr. 2013;25:1065–76.CrossRefPubMed
54.
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–26.CrossRefPubMedPubMedCentral
55.
Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5:63.CrossRefPubMedPubMedCentral
56.
Pawson R. The Science of Evaluation: A Realist Manifesto. London: Sage; 2013.CrossRef
57.
Pearson M, Brand SL, Quinn C, Shaw J, Maguire M, Michie S, Briscoe S, Lennox C, Stirzaker A, Kirkpatrick T, Byng R. Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health. Implement Sci. 2015;10:134.CrossRefPubMedPubMedCentral
58.
59.
60.
61.
62.
Public Health England & National Health Service England. A Guide to Community-Centred Approaches for Health and Wellbeing. Full Report. London: Public Health England; 2015.
63.
Metadata
Title
Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care
Authors
Helen M. Lloyd
Mark Pearson
Rod Sheaff
Sheena Asthana
Hannah Wheat
Thava Priya Sugavanam
Nicky Britten
Jose Valderas
Michael Bainbridge
Louise Witts
Debra Westlake
Jane Horrell
Richard Byng
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Health Research Policy and Systems / Issue 1/2017
Electronic ISSN: 1478-4505
DOI
https://doi.org/10.1186/s12961-017-0263-z

Other articles of this Issue 1/2017

Health Research Policy and Systems 1/2017 Go to the issue

Review

Operations research in global health: a scoping review with a focus on the themes of health equity and impact

Research

Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study

Research

A need to accelerate health research productivity in an African University: the case of Makerere University College of Health Sciences

Research

Tracking implementation strategies: a description of a practical approach and early findings

Research

The role of NGOs’ service delivery experience in developing relevant research agendas: experience and challenges among NGOs in Malawi

Review

Measuring research impact in Australia’s medical research institutes: a scoping literature review of the objectives for and an assessment of the capabilities of research impact assessment frameworks