Integrating data into decision making can lead to more efficient resource use by delivering more targeted, patient-centered care and reducing hospital admissions. However, the evidence for cost reduction is mixed due to the complex nature of integration and difficulties attributing effects. Studies find the most important factors for successful integration are simplifying interactions through single assessments, co-locating services, and maximizing each patient contact with a single point of contact. To better evaluate integration, agreed definitions, standardized metrics, clarity on success measures, robust methods, and patient-centered data collection are needed.

1. Integrating Data into Decision
Making
Tony O’Connor CBE
Deputy Director, DH Strategy Group
June 2014

2. 2
The financial pressures on the health and care system
are well understood
The NHS Productivity Challenge - The King’s Fund May 2014
Funding flat?
Cost
Pressures UP

3. 3
Delivery of a more patient centred targeted
care system and reducing hospital admissions
should lead to more efficient resources.
But where is the evidence?

4. 4
Breadth of Integration
Vertical
Strategies that link different levels of specialisation from primary, secondary and
tertiary care services.
Horizontal
Strategies that link similar levels of care such as primary, community and social care
services.
Level of Integration
System
Structures, processes and techniques are tailor-made to fit the needs of the
population served across the continuum of care.
Organisational
The extent to which organisations coordinate services through inter-organisational
relationships (e.g., contracting, strategic alliances, knowledge networks, mergers),
including common governance mechanisms.
Professional
Inter-professional partnerships based on shared competences, roles, responsibilities
and accountability.
Service
The coordination of services in a single process across time, place and discipline to
deliver person-focused care.
Degree of Integration
Normative
The development and maintenance of common vision, values and culture between
organisations, professional groups and individuals.
Functional
Key support functions (i.e., financial, management and information systems) are
structured around the primary process of service delivery to support accountability
and decision-making.
Source: Adapted from Valentijn et al (2013)
Different forms of integration

5. 5
The larger systematic reviews including a recent one by the
Centre for Health Economics failed to identify clear evidence
for cost reduction. Reasons?
• Complex nature of the concept
• Lack of a consistent taxonomy;
• Lack of clearly defined outcomes and use of appropriate
controls  hard to attribute effects to the intervention;
• Nature of the client group and types of intervention mean
improvements in health are unlikely and benefits may be
realised in other areas over long time periods;
• Strong supply side drivers make it difficult to effectively
reduce hospital use. We need to have a clearer
understanding of what is realistic;
The evidence base on integration
is still in its infancy

6. 6
Studies of successful integration schemes suggest that the
most important factors relate to
• simplifying the way people interact with services though
adopting single assessment processes,
• co-location of services and
• maximising each care contact.
This can be enhanced by having a single individual in a co-
ordinating role to act as single point of contact with authority
to refer to other services.
Characteristics of successful integration

7. 7
Overall evidence for the impact of integration on outcomes
and secondary care utilisation is mixed at best
1
2
1
5
2
12
15
Impactoncost
Impact on quality
PositiveMixedNone
Source: Adapted from Centre for Health Economics (2012)
PositiveMixedNone
Impact of 38 international integrated care schemes on outcomes and secondary care costs

8. 8
Compared to other countries, in England there have been more
integration initiatives but methods applied have lacked robustness
0%
20%
40%
60%
80%
100%
QualitativeUncontrolledMixed methodsAnalysis of
routine data
Non-randomised
controlled trials
Randomised
controlled trials
Proportion of integration studies by primary research method
Seven other countries (N=25) England (N=13)
Source: Centre for Health Economics (2012)

9. 9 The Age of Analytics, April 30th 2014 – Sir Mark Walport – Gov Chief Scientist
In general privacy controls are not binary but fall on spectra
Obfuscation
Openly identifiable
Anonymised to the
point of losing
valuable content
Access / Environment
Free on the
internet
Locked in a steel-
lined room
Governance and
accountability
Little legislation Highly legislated
(Everyone) (Accredited researcher)
The challenge is to find the appropriate level of control for each data system
More safe?More Useful?
Big Data - Confidence, Access and Security

10. 10
• Agreed taxonomy
• Clear, collectable metrics
• Clarity around what is success
• Robust evaluation methods
• Patient centred data collection (big data,
data analytics)
What do we need to evaluate integration