SUPPORTING THE SPREAD OF EFFECTIVE INTEGRATION MODELS FOR OLDER PEOPLE LIVING IN CARE HOMES: A MIXED METHOD APPROACH

Background: Health and social care systems in many countries have begun to trial and adopt “integrated” approaches. The significant role care homes play within the system is often understated. Care homes provide bed capacity for the system, are frequently involved in hospital care transitions, influence health outcomes and costs, including preventable care costs. However, the optimal mix of integration initiatives, when and in what context is unknown. Methods: We identified integration interventions referenced in official documents by customising and using existing artificial intelligence methods. Collected information were synthesised in a ‘policy map’, validated by researchers and panel discussions with experts and PPI/E representatives. We used collated information as the basis for a new general typology for mapping integrated care policies in the care home sector. Using multivariate regression models, we investigated the relationships between local contextual and care market factors, the extent of integration and key social care and health systems performance indicators. Statistical indices were used in assessing the between-/within- variability of integration policies in the 42 Integrated Care Systems developed in England. Results: We found that while there is national direction of care home integration-related policy (in line with the EHCH framework), there is also local innovation, which is important to capture. Several initiatives showed an emphasis on: monitoring quality; workforce training; and service delivery changes (e.g. multidisciplinary teams). We found comparatively little emphasis on financing and other incentive changes to stimulate socially-relevant private provider behaviour in the care home sector. However, the most promising initiatives in terms of beneficial associations with outcomes were not the most widespread initiatives. The analysis at ICS level has found significant variation within implementing ICSs with the exception of ICSs like Greater Manchester (with its devolution from 2016, it effectively offered a pilot ICS prior to national ICS rollout). This signals the potentials of the ICS structure to encourage spread of innovation. On the other hand, it is not obvious how much any: additional implementation funding; historical working relationships; or national assistance, might support effective adoption. However, we have also identified a significant number of ICSs which had relatively low/no adoption of any care home integration domains, and these will necessarily have to look elsewhere for any learning opportunities. Conclusions: Current care home integration policies appear to be: at an early stage; at smaller-scale; focused on integration with single providers, or on more generally quality monitoring the sector by healthcare agencies; and focussed on the input of healthcare providers to workforce training to generally improve care. There is also a mix of locally- and nationally-directed policy, leading to variation in what is enacted across localities. Existing frameworks were not suitable for fully capturing this variation, and we have filled this gaps. We provided tools and results that will help ICSs to: recognise what is already in practice across their geographies; support the understanding of what might work best and why; identify areas for improvement; and encourage good practice for an efficient/effective scaling-up or deactivation.