MDT case study

Community-Based Multidisciplinary Teams in England

• Multidisciplinary teams (MDTs) in England include patients and their representatives and operate in various settings, not exclusive to health and social care.
• MDTs use risk-stratification tools and care planning to identify and address the needs of high-risk patients, such as those with complex health conditions or social risk factors.
• The IAU evaluated three MDT initiatives in England, comparing outcomes of patients receiving care from MDTs to a comparison group with similar characteristics.
• The evaluations focused on the effect of MDTs on A&E attendances and emergency hospital admissions, using routine health data for analysis.
• The MDT initiatives evaluated were Integrated care teams (ICTs) in North East Hampshire and Farnham (NEHF), Extensive care services (ECS) in Fylde Coast, and Enhanced primary care (EPC) in Fylde Coast.
• All three programs were community-based and targeted patients at higher risk of emergency hospital use, consisting of medical and non-medical staff meeting regularly to plan and coordinate services.
• There were differences in the referral criteria and patient identification for the MDTs, with some programs replacing patients' usual GP, while others provided additional support to GP care.
• These MDT programs were part of the New Care Models vanguard program, aiming to reduce unnecessary emergency hospital use, and covered areas with varied demographics, rurality, and deprivation.
• The Integrated Care Transformation program in Mid-Nottinghamshire, which included MDTs, also received vanguard status in 2015.
• The IAU's evaluation findings may not reflect the current impact of the MDTs, as the programs evaluated are likely to have evolved since the study periods.
• The IAU's evaluation findings were used to inform efforts to develop more integrated care in England and were put in the context of broader evidence on the effect of community-based MDTs in the UK and other countries.
• The IAU's review of the evidence focused on MDTs involving at least one health care professional, and the methods used for evaluation are detailed in the Appendix.

Community-Based Multidisciplinary Teams: Evaluations and Evidence

• Fylde Coast introduced support for frequent 999 callers, while Mid-Nottinghamshire introduced proactive care planning for frequent A&E service users.
• Evaluations by the IAU covered areas like Fylde, Wyre, Blackpool, and NEHF, comparing emergency hospital use before and after the integrated care programmes.
• The IAU also evaluated the Integrated Care Transformation programme in Mid-Nottinghamshire, including MDTs as a main initiative.
• The evaluations compared emergency hospital use against comparable areas in England for a period ranging from 4.5 to 6 years.
• A rapid review of systematic reviews on the impacts of community-based MDTs included eight studies, focusing on MDTs from high-income countries, including the UK.
• The quality of evidence from the reviewed studies was weak, with most focusing on older people with complex needs as the common target group for MDTs.
• Across the three MDT programmes evaluated, emergency hospital use among those enrolled in MDTs was higher than for those in the comparison groups over the study periods.
• Potential limitations of the analysis included subtle differences between the groups, such as patients being more severely ill in the MDT group in Fylde Coast.
• The evaluations covered the areas of Fylde and Wyre, Blackpool, and NEHF, comparing emergency hospital use before and after the integrated care programmes.
• The IAU evaluated the broader integrated care programmes that implemented the three MDTs over a longer time period.
• The evaluations compared emergency hospital use against comparable areas in England for a period ranging from 4.5 to 6 years, considering the whole populations aged 18 years and older and 65 years and older, respectively.
• The reviews studied MDTs in a mix of ways, including interventions that make use of MDTs, such as community mental health teams for older people and intensive primary care support, among others.