Supporting the spread of effective integration models for older people living in care homes: A mixed method approach

Research question: The project seeks to identify, classify and compare the types and extent of locally-implemented integrated care policies in relation to care homes in England. Background: Closer integration of social care and health services is a policy priority in many countries.

The NHS Long Term Plan committed to rolling-out innovative integration practices across England with a specific emphasis on initiatives aimed at care home residents. However, the optimal mix of integration care home initiatives, when and in what context is unknown.

Comprehensive knowledge of existing integrated initiatives, their types, the factors which enable or hamper implementation and their effect on key outcomes is key to supporting their efficient and effective, national roll-out.

Aims and objectives: We will create an online policy extraction and mapping tool that allows commissioners, advocates of potential/current care-users and researchers to examine the presence and extent of local care home integration interventions across England.

Data will be summarised in accessible ways to rank localities across multiple domains of integration and to examine the association of these domains with key indicators of social care and health system performance, with care home market characteristics and local authorities procurement strategies being mediating/moderating factors.

Findings will empower: i) care service users /relatives decision-making, through transparent and accessible information; ii) local commissioners, by better shared learning on best practices; iii) national decision-makers, to track the progress of integration and to support the scale-up of best-practice; and iv) researchers, by enabling comparison of locally implemented integration interventions implemented.

Methods: We will identify integration interventions referenced in official documents by customising and using existing artificial intelligence methods (text mining and machine learning).

The information we collect will be synthesised in a policy map (grid of interventions by locality and year), validated by researchers during piloting, and by a national survey about local policymaker activity.

We will construct a diagnostic index of integration using latent factor structural equation models, validated by panel discussions with experts and PPI/E representatives.

We will investigate the relationships between local contextual and care market factors, the extent of integration and key social care and health systems performance indicators using multivariate regression models.

Timelines for delivery: The project will be delivered in 24 months, including an initial 6 months piloting in Greater Manchester with results disseminated in month 7, and subsequent national scale-up, with results disseminated in months 13, 20, 21 and 24.

Anticipated impact and dissemination: Decision-makers, provider organisations, local community groups and also individual service users and carers must consider carefully how to make informed use of the resources available to them. We will consult with them to maximise impact and disseminate results effectively in a variety of formats.

Our outcomes will: i) promote informed decision-making and incentivise best-practice; ii) track changes in integration to support national roll-out; iii) support local authorities in market shaping and in `fostering service quality; iv) provide evidence on the optimal mix of integration activities that maximise improvements in residents outcomes.