Podcast
Questions and Answers
What is the main focus of community-based multidisciplinary teams (MDTs) mentioned in the text?
What is the main focus of community-based multidisciplinary teams (MDTs) mentioned in the text?
- Reducing emergency hospital use in the short term
- Implementing reforms to the NHS in England
- Providing care for adults with complex health and care needs (correct)
- Coordinating primary care services
What is a common approach in the development of community-based multidisciplinary teams (MDTs)?
What is a common approach in the development of community-based multidisciplinary teams (MDTs)?
- Focusing on reducing emergency hospital use in the short term
- Involving only health professionals in planning and coordinating care
- Being based around general practices (correct)
- Establishing area-based integrated care systems (ICSs)
What did the Improvement Analytics Unit (IAU) evaluations find regarding the impact of MDTs on emergency hospital use?
What did the Improvement Analytics Unit (IAU) evaluations find regarding the impact of MDTs on emergency hospital use?
- MDTs had no impact on emergency hospital use
- MDTs led to significant reductions in emergency hospital use
- MDTs consistently reduced emergency hospital use across all evaluations
- MDTs did not reduce emergency hospital use in the short term (correct)
What was the timeframe for observing reductions in emergency hospital use as a result of the broader programmes in which MDTs were implemented?
What was the timeframe for observing reductions in emergency hospital use as a result of the broader programmes in which MDTs were implemented?
What did studies assessing the impact of MDTs on health outcomes find?
What did studies assessing the impact of MDTs on health outcomes find?
What was the longer-term impact of integrated care programmes across outcomes, vanguard areas, and population groups?
What was the longer-term impact of integrated care programmes across outcomes, vanguard areas, and population groups?
What was the overall impact of MDTs on emergency hospital use initially?
What was the overall impact of MDTs on emergency hospital use initially?
What did evidence indicate about emergency admissions and average length of stay in certain areas over 3 to 5 years?
What did evidence indicate about emergency admissions and average length of stay in certain areas over 3 to 5 years?
What was the trend towards A&E attendances over time?
What was the trend towards A&E attendances over time?
In which area was there a trend towards lower emergency admissions rates in years 5 and 6?
In which area was there a trend towards lower emergency admissions rates in years 5 and 6?
What did meta-analyses of nurse-led integrated care models involving MDTs find?
What did meta-analyses of nurse-led integrated care models involving MDTs find?
What is the ambition for ICSs and MDTs?
What is the ambition for ICSs and MDTs?
What was the broader evidence of MDT impact?
What was the broader evidence of MDT impact?
What are MDTs a core part of efforts to provide?
What are MDTs a core part of efforts to provide?
What did a meta-analysis of nurse-led integrated care models find regarding the impact on hospital admissions or emergency department visits?
What did a meta-analysis of nurse-led integrated care models find regarding the impact on hospital admissions or emergency department visits?
What did the evidence indicate about the impact of MDTs on hospital measures, including elective admissions and outpatient appointments?
What did the evidence indicate about the impact of MDTs on hospital measures, including elective admissions and outpatient appointments?
What was the focus of the IAU's evaluation of the MDT initiatives in England?
What was the focus of the IAU's evaluation of the MDT initiatives in England?
What was the aim of the New Care Models vanguard program?
What was the aim of the New Care Models vanguard program?
Which areas did the MDT programs covered under the New Care Models vanguard program target?
Which areas did the MDT programs covered under the New Care Models vanguard program target?
What was the composition of the MDTs in England?
What was the composition of the MDTs in England?
What was the role of the Integrated Care Transformation program in Mid-Nottinghamshire?
What was the role of the Integrated Care Transformation program in Mid-Nottinghamshire?
What did the IAU's evaluation findings inform efforts to develop in England?
What did the IAU's evaluation findings inform efforts to develop in England?
What were the differences in the referral criteria and patient identification for the MDTs?
What were the differences in the referral criteria and patient identification for the MDTs?
What was the focus of the IAU's review of the evidence on MDTs?
What was the focus of the IAU's review of the evidence on MDTs?
What did the MDT initiatives in England use to identify and address the needs of high-risk patients?
What did the MDT initiatives in England use to identify and address the needs of high-risk patients?
What did the MDT initiatives in England aim to reduce?
What did the MDT initiatives in England aim to reduce?
What type of patients were the MDT programs in England targeting?
What type of patients were the MDT programs in England targeting?
What did the IAU's evaluation findings focus on?
What did the IAU's evaluation findings focus on?
What was the main focus of the rapid review of systematic reviews on the impacts of community-based MDTs?
What was the main focus of the rapid review of systematic reviews on the impacts of community-based MDTs?
What was a potential limitation of the analysis of the three MDT programmes evaluated?
What was a potential limitation of the analysis of the three MDT programmes evaluated?
What did the IAU's evaluations compare emergency hospital use against?
What did the IAU's evaluations compare emergency hospital use against?
What was the focus of the reviews studied in the rapid review of systematic reviews on the impacts of community-based MDTs?
What was the focus of the reviews studied in the rapid review of systematic reviews on the impacts of community-based MDTs?
What was the timeframe for the evaluations comparing emergency hospital use before and after the integrated care programmes?
What was the timeframe for the evaluations comparing emergency hospital use before and after the integrated care programmes?
What was the quality of evidence from the reviewed studies in the rapid review of systematic reviews on the impacts of community-based MDTs?
What was the quality of evidence from the reviewed studies in the rapid review of systematic reviews on the impacts of community-based MDTs?
What did the evaluations by the IAU cover in addition to Fylde and Mid-Nottinghamshire?
What did the evaluations by the IAU cover in addition to Fylde and Mid-Nottinghamshire?
What was the main initiative of the Integrated Care Transformation programme in Mid-Nottinghamshire?
What was the main initiative of the Integrated Care Transformation programme in Mid-Nottinghamshire?
What did the reviews in the rapid review of systematic reviews on the impacts of community-based MDTs focus on?
What did the reviews in the rapid review of systematic reviews on the impacts of community-based MDTs focus on?
What were the populations considered in the evaluations comparing emergency hospital use before and after the integrated care programmes?
What were the populations considered in the evaluations comparing emergency hospital use before and after the integrated care programmes?
What was the trend regarding emergency hospital use among those enrolled in MDTs over the study periods?
What was the trend regarding emergency hospital use among those enrolled in MDTs over the study periods?
Flashcards
MDTs in England
MDTs in England
Multidisciplinary teams in England that bring together healthcare professionals, patients, and their representatives to address complex healthcare needs, operating in various settings.
Risk-stratification
Risk-stratification
A method used by MDTs in England to identify patients at higher risk of complications or needing specialized care due to complex health conditions or social factors.
Care planning in MDTs
Care planning in MDTs
Care plans designed by MDTs in England to provide tailored support for high-risk patients, addressing individual needs and coordinating services.
IAU (Independent Assessment Unit)
IAU (Independent Assessment Unit)
An independent organization that evaluates the effectiveness of healthcare interventions in England, including MDT initiatives.
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MDT evaluation focus
MDT evaluation focus
The objective of evaluating MDT initiatives in England, to determine the impact on emergency hospital use, especially for high-risk patients.
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Integrated Care Teams (ICTs)
Integrated Care Teams (ICTs)
Integrated care teams (ICTs) in North East Hampshire and Farnham (NEHF) were one of the three MDT programs evaluated by the IAU in England.
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Extensive Care Services (ECS)
Extensive Care Services (ECS)
Extensive care services (ECS) in Fylde Coast were another MDT program evaluated in England.
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Enhanced Primary Care (EPC)
Enhanced Primary Care (EPC)
Enhanced primary care (EPC) in Fylde Coast made up the third MDT program evaluated in England.
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Community-based MDTs
Community-based MDTs
All three MDT programs evaluated by the IAU in England were community-based, targeting patients at higher risk of emergency hospital use.
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Regular MDT meetings
Regular MDT meetings
A key aspect of the evaluated MDTs, the regular meetings of medical and non-medical professionals to coordinate services and plan care for high-risk patients.
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New Care Models Vanguard
New Care Models Vanguard
The New Care Models Vanguard program in England, where the evaluated MDTs were part of, aiming to reduce unnecessary emergency hospital use.
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Integrated Care Transformation
Integrated Care Transformation
The Integrated Care Transformation program in Mid-Nottinghamshire, also part of the New Care Models Vanguard, implementing MDTs as a key initiative.
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Evolution of MDTs
Evolution of MDTs
The IAU recognized that MDT programs, like the ones evaluated, may evolve over time, making their findings relevant to the specific time period studied.
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Informing integrated care
Informing integrated care
The IAU's findings were used to guide broader efforts to develop more integrated care systems in England, incorporating lessons learned from the MDT evaluations.
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Global context for MDTs
Global context for MDTs
The IAU placed their findings on MDTs in England within a broader context by examining existing evidence on community-based MDTs in the UK and other countries.
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MDT focus on older adults
MDT focus on older adults
The IAU's review of evidence on community-based MDTs included interventions specifically focusing on older adults with complex healthcare needs, a common target group for this type of care.
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Pre-post analysis of MDTs
Pre-post analysis of MDTs
The IAU compared emergency hospital use for patients enrolled in MDTs to a comparison group over a set study period, allowing for a before-and-after analysis of the impact.
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MDT impact inconclusive
MDT impact inconclusive
The IAU's evaluation found that overall, across the three MDT programs, emergency hospital use among patients enrolled in the MDTs was higher than for those in the comparison groups.
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MDT evaluation limitations
MDT evaluation limitations
Potential limitations of the MDT evaluations include the possibility of subtle differences between the MDT group and the comparison group that could have biased the results.
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Integrated care program evaluation
Integrated care program evaluation
The IAU evaluates the broader integrated care programs that implemented the three MDTs (ICTs, ECS, and EPC) over a longer time period.
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Long-term MDT impact analysis
Long-term MDT impact analysis
The IAU compared emergency hospital use against comparable areas in England for a period ranging from 4.5 to 6 years, using routine health data for analysis.
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Analyzing impact across age groups
Analyzing impact across age groups
The IAU included both younger and older adults in their analysis, examining the impact of the MDT programs on emergency hospital use in the whole population aged 18 years and older and 65 years and older respectively.
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Rapid review of community-based MDTs
Rapid review of community-based MDTs
A rapid review on the impacts of community-based MDTs, incorporating findings from eight studies, including those conducted in high-income countries.
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Focus on older adults in research
Focus on older adults in research
Most studies included in the rapid review focused on older adults with complex needs, highlighting the common target group for MDTs in high-income countries.
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Quality of MDT research
Quality of MDT research
The quality of evidence from the reviewed studies was deemed as weak, indicating a need for further rigorous research to fully understand the effectiveness of community-based MDTs.
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Three MDT initiatives evaluated
Three MDT initiatives evaluated
In total, the IAU evaluated three distinct MDT initiatives in England: ICTs in NEHF, ECS and EPC in Fylde Coast, each with unique features and targets, contributing to a varied understanding of MDTs.
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Complexity of MDT evaluation
Complexity of MDT evaluation
The IAU's evaluation findings, while offering insights, are limited by the complexity of the interventions and the potential for unmeasured factors to influence outcomes.
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MDT programs within broader initiatives
MDT programs within broader initiatives
The MDT programs evaluated by the IAU were part of broader initiatives aimed at transforming healthcare delivery, making it crucial to analyze their impact within the context of these larger goals.
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Regional variations in MDT impact
Regional variations in MDT impact
The evaluations of MDTs highlighted the importance of considering regional variations in demographics, rurality, and deprivation levels, as these factors may influence the effectiveness of the programs.
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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.
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