Childrens Integrated Healthcare Design and Evaluation

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Childrens Integrated HealthcareDesign and
Evaluation

• Dr Ingrid Wolfe
• Public Health and Research Lead
• National Collaborative for CIH
• May 2008

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Integrated Working

• ..is everyone supporting children and young
  people working together effectively to put the
  child at the centre, meet their needs and improve
  their lives.
• Every Child Matters Change for Children

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Integrated Working

• combines professional expertise, knowledge and
  skills
• is collaboration and coordination at all levels,
  across all services, in both single and
  multi-agency settings
• Every Child Matters Change for Children

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Integrated Working

• involves the child or young person and family
  (earlier)
• Every Child Matters Change for Children

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Integrated Care

• is a coordinated package of support centred on
  the child or young person, to help to secure
  better outcomes for them.
• Every Child Matters Change for Children

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Childrens Trusts
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Integrated Working - Childrens Trusts
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CIH Aims

• To design healthcare service tailored to needs of
  children and families
• To improve shortfalls in quality and access in
  current service provision
• Provide service that transcends barriers between
  primary and secondary care
• To meet challenges of WTD 2009

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CIHWhy?

• Poor progress in meeting needs of children
• Out-of-hours care
• 30 increase in ED admissions
• Poor support for long-term conditions
• Inferior outcomes, inconvenient services
• Changing needs expectations

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Optimum Care for Children

• Appropriately trained professionals
• Child-friendly environment
• As close to home as possible
• Integrated services for LTC for full
  participation in home and school
• Integrated health, social, mental, educational
  services for holistic care.

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CIH could offer

• Unscheduled care
• Follow-up clinics
• Referral clinics
• Child development services
• Mental health clinics
• Health promotion
• Family support

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CIHHypothesis-testing

• Generic model of CIH
• Test
• Clinical activity
• Workforce
• Finance
• Patients perspective

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CIHPilot-evaluation

• Local CIH model
• Indicators
• Clinical activity
• Workforce
• Patients perspectives
• Finance

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CIHGeneric Model

• Structures
• Processes
• Outputs Outcomes

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CIHGeneric ModelStructures

• Co-located primary and secondary care childrens
  health professionals
• DGH affiliated CIH centres linked GP centres

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GP
GP
Extended School
CIH
GP
GP
Childrens Centre
CIH
GP
GP
GP
GP
DGH
GP
GP
CIH
GP
GP
CIH
GP
GP
GP
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CIHGeneric ModelProcesses

• Assess needs to determine what services CIH
  centres should offer

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Needs Assessment

• Population size
• Characteristics
• Trends
• Ethnicity
• Deprivation
• Particulars

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Needs Assessment

• ECM outcomes
• Being healthy
• Staying safe
• Enjoying and achieving
• Making a positive contribution
• Achieving economic well-being
• Services
• Planned
• Unplanned

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Needs AssessmentUnplanned Services
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Needs AssessmentPlanned Services

• Routine population-based care
• Long-term conditions
• CAMHS
• Allied Health Professionals
• Vulnerable and abused
• Learning difficulties, sensory impairments

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CIHProcesses

• Services from 8 till late
• Childrens healthcare professionals working
  together in planned and unplanned services
• Training
• Advice and assistance available on-hand
• Convenient team-based planned care for LTC
• Information-sharing

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CIH Outputs and Outcomes

• follow from
• aims
• processes
• and determine indicators

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CIH Aims

• To design healthcare service tailored to needs of
  children and families
• To improve shortfalls in quality and access in
  current service provision
• Provide service that transcends barriers between
  primary and secondary care
• To meet challenges of WTD 2009

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Indicators

• should be used to understand, to compare, and to
  improve

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Indicators

• For understanding how a system works and how it
  might be improved
• For performance monitoring (meeting agreed
  standards)
• For accountability

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Indicators

• Must address important issues
• Must be scientifically valid

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Indicators

• All professionals can call upon advice and
  assistance from colleagues in the same centre

• Shared use of clinical protocols and guidelines
• Number of contacts with professionals till
  diagnosis and treatment
• Workforce numbers

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Indicators

• Planned care of LTCs in more convenient place for
  families, allow multidisciplinary team-based
  care. One-stop shop service.

• Patient satisfaction
• Numbers of appointments with different healthcare
  professionals
• Secondary care admission and referral rates

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Indicators

• Improve management of long-term conditions

• No.admissions for sentinel LTCs
• No. separate appts different professionals but
  same condition
• No. appts specialist paediatricians/ community
  paediatric nurses/allied health professionals
• No. school days missed for hospital appointments
• No.parents work days missed for hospital
  appointments

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Indicators

• Improved health outcomes by providing prompt
  access to expertise, with family-based approach
  and using common protocols and improving
  information sharing.

• Clinical effectiveness outcome measures for
  sentinel conditions
• Sharing clinical protocols and guidelines
• Sharing patient-information

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Indicators

• Reduce short stay (4-24 hours) emergency
  admissions for acute illnesses by improving care
  outside hospital

• Number of emergency admissions 4-24 hours duration

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Indicators

• Reduce direct, indirect, and opportunity costs by
  providing immediate access to the most
  appropriate professional in one appointment
  instead of 2 or more

• Cost per completed episode of acute illness
• Cost per annum for management of LTCs
• Other cost indicators
• Establishing CIH centre
• Recurrent costs (staff, supplies, maintenance)

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Structure Process Outcomes
GP
Extended School
CIH
GP
GP
GP
Childrens Centre
CIH
GP
GP
GP
GP
DGH
GP
GP
CIH
GP
GP
CIH
GP
GP
GP