Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot

2.50
Hdl Handle:
http://hdl.handle.net/10547/582871
Title:
Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot
Authors:
Harris, Matthew; Greaves, Felix; Gunn, Laura; Patterson, Sue; Greenfield, Geva; Car, Josip; Majeed, Azeem; Pappas, Yannis
Abstract:
Background: In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working. Methods: We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and transcribed Case Discussions. Two coders independently coded utterances according to their ‘integrative intensity’ which was defined against three a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standardised weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how integrative intensity changed during the conversations. Results: Twenty-three Case Discussions in four different Multidisciplinary Groups were transcribed and coded. Inter- and intra-rater reliability was good as shown by the Prevalence and Bias-Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; presenting general practitioner 38.75%; Chair 7.8%; nonpresenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrative intensity; however, there was a gradual increase (R2 = 0.71) in integrative intensity during the Case Discussions. Based on the analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward. Interpretation: We characterise the Multidisciplinary Groups as having consultative characteristics with some trend towards collaboration, but that best resemble Community-Based Ward Rounds. Although integration scores do increase from the beginning to the end of the Case Discussions, this does not tend to translate into actions for the groups to take forward. The role of the Chair and the improved participation of non-presenting general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the Multidisciplinary Groups. This suggests that more could be done to sensitise participants to the value of full participation from all the members of the group. The method we have developed could be used for ongoing and future evaluations of integrated care projects.
Affiliation:
Imperial College London; Stetson University; University of Queensland; University of Bedfordshire
Citation:
Harris, M., Greaves, F., Gunn, L., Patterson, S., Greenfield, G., Car, J., Majeed, A., Pappas, Y (2013). Multidisciplinary integration in the context of integrated care-results from the North West London Integrated Care Pilot. International Journal of Integrated Care 13.
Publisher:
Igitur Publishing
Journal:
International Journal of Integrated Care
Issue Date:
Oct-2013
URI:
http://hdl.handle.net/10547/582871
PubMed ID:
24198737
PubMed Central ID:
PMC3817952
Additional Links:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817952/pdf/IJIC-13-2013041.pdf; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817952/
Type:
Article
Language:
en
ISSN:
1568-4156
Appears in Collections:
IHR Institute for Health Research

Full metadata record

DC FieldValue Language
dc.contributor.authorHarris, Matthewen
dc.contributor.authorGreaves, Felixen
dc.contributor.authorGunn, Lauraen
dc.contributor.authorPatterson, Sueen
dc.contributor.authorGreenfield, Gevaen
dc.contributor.authorCar, Josipen
dc.contributor.authorMajeed, Azeemen
dc.contributor.authorPappas, Yannisen
dc.date.accessioned2015-11-30T10:54:04Zen
dc.date.available2015-11-30T10:54:04Zen
dc.date.issued2013-10en
dc.identifier.citationHarris, M., Greaves, F., Gunn, L., Patterson, S., Greenfield, G., Car, J., Majeed, A., Pappas, Y (2013). Multidisciplinary integration in the context of integrated care-results from the North West London Integrated Care Pilot. International Journal of Integrated Care 13.en
dc.identifier.issn1568-4156en
dc.identifier.pmid24198737en
dc.identifier.urihttp://hdl.handle.net/10547/582871en
dc.description.abstractBackground: In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working. Methods: We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and transcribed Case Discussions. Two coders independently coded utterances according to their ‘integrative intensity’ which was defined against three a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standardised weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how integrative intensity changed during the conversations. Results: Twenty-three Case Discussions in four different Multidisciplinary Groups were transcribed and coded. Inter- and intra-rater reliability was good as shown by the Prevalence and Bias-Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; presenting general practitioner 38.75%; Chair 7.8%; nonpresenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrative intensity; however, there was a gradual increase (R2 = 0.71) in integrative intensity during the Case Discussions. Based on the analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward. Interpretation: We characterise the Multidisciplinary Groups as having consultative characteristics with some trend towards collaboration, but that best resemble Community-Based Ward Rounds. Although integration scores do increase from the beginning to the end of the Case Discussions, this does not tend to translate into actions for the groups to take forward. The role of the Chair and the improved participation of non-presenting general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the Multidisciplinary Groups. This suggests that more could be done to sensitise participants to the value of full participation from all the members of the group. The method we have developed could be used for ongoing and future evaluations of integrated care projects.en
dc.language.isoenen
dc.publisherIgitur Publishingen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817952/pdf/IJIC-13-2013041.pdfen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817952/en
dc.subjecthealth care deliveryen
dc.subjectcommunicationen
dc.subjecthealth servicesen
dc.subjectmultidisciplinary groupsen
dc.subjectL510 Health & Welfareen
dc.subjectintegrated careen
dc.subjectintegrated health care systemsen
dc.titleMultidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Piloten
dc.typeArticleen
dc.contributor.departmentImperial College Londonen
dc.contributor.departmentStetson Universityen
dc.contributor.departmentUniversity of Queenslanden
dc.contributor.departmentUniversity of Bedfordshireen
dc.identifier.journalInternational Journal of Integrated Careen
dc.identifier.pmcidPMC3817952en
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