The document summarizes research conducted by the NIHR Health Services and Delivery Research programme on integrated care. It outlines several research projects funded through specific calls on integrated care between 2009-2011, including evaluations of case management initiatives, self-care support, and virtual wards. The research aims to identify healthcare managers' needs and generate evidence to improve services. The programme commissions applied health research to benefit the NHS based on both need and scientific merit.

1. Building a portfolio of research
findings
for use by healthcare managers and decision-makers using
integrated care as a sample theme
NIHR Health Services and Delivery Research programme
Matt Westmore, Director of NETSCC
Steph Garfield-Birkbeck, Assistant Director
Donna White, Research Fellow

2. Who are we – what do we do?
National Institute for To have an
Health Research IMPACT
What research
do managers
£1bn (€1.2bn)/year Health Services and need to deliver
Delivery Research good services?
Applied health programme
research system
C£16m (€19.8m)
for the Focus on quality and
UK’s NHS effectiveness of
healthcare systems
Therefore we assess research topics for need BEFORE scientific merit

3. What do we mean by need?
Ability to benefit – mediated through service organisation and delivery
3
Stevens, A. and Raftery, J. (1994) Health Care Needs Assessment: The Epidemiologically Based Needs Assessment Reviews.
Oxford: Radcliffe Medical

4. Identifying need (the right research questions)
Engaging with the research-using community; meeting its needs
Collect suggestions for research throughout the year from individuals, patients,
public, professionals, literature, societies and groups
Annual stakeholder engagement exercise involving senior managers, service
providers and some academics
Further selection and prioritisation by a standing panel made up of external (to us)
independent NHS managers, clinicians, researchers
Literature and evidence summary written and reviewed by experts
Call for research advertised. Final list of approved topics forms the research agenda for
the HS&DR programme
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5. What do we mean by integration?
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6. Integrated care portfolio: April 2009 – Sept 2011
Specific calls for research relevant to integrated care
Call title Funding
Evaluating Innovations in Integrating Health £2m (€2.5m)
Research on Primary Care and Community care and Community Health Services £3m (€3.7)
NHS Care Homes £3m (€3.7)
Patient safety in healthcare organisations £2m (€2.5m)
Expedited evidence synthesis to support decision-making by managers and leaders in the NHS £50k-80k (~€80k)
per project
Total portfolio (specific calls and open calls) Research type
Projects funded 42
Funding £14.5m (€18m) out of £35m
committed (€43m) across all calls
Mean cost £350k (€430k)
Mean duration 31 months
Secondary
6
only 9%

7. Completed research In progress
‘Self care and case management in ‘Assessing outcomes of integrated
care for people with long term
long term conditions’, Professor David conditions’, Professor Gillian Parker, Uni’ of
Challis, April 2008 York
•Map current provision •How health and social care services
•integrated care initiatives as have been integrated?
determinants for entry to and exit •What outcomes do people with long
from case management term conditions want?
‘Self management support among ‘Analysis of virtual wards’, Dr Geraint
older adults’, Ms Suzanne Parsons, April Lewis, Nuffield Trust
2010
•Do 'Virtual Wards' lead to changes in
•experiences and expectations use of care?
•What are the costs and savings of
Virtual Wards?
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All have project webpages with descriptions, protocol and final reports

8. Mensajes para llevar a casa
(take home messages)
• NIHR Health Service and Delivery Programme is focussed on evidence for UK NHS
healthcare managers and decision-makers.
• We commission research based on the need of the NHS in addition to scientific merit
• We have commissioned a significant and balanced portfolio of research relevant to
integrated care
• All will publish freely available comprehensive final reports on our website
Further information
hsdrinfo@southampton.ac.uk
NIHR stand
www.nihr.ac.uk in the
www.netscc.ac.uk/hsdr/
exhibition!
@officalNIHR - #NIHR
Paper submitted to Journal of Integrated Care
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This presentation presents independent research funded by the National Institute for Health Research (NIHR). The views
expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

9. ADDITIONAL SLIDES
9

10. Example completed Research
‘Self care and case management in ‘Self management support among
long term conditions’, older adults’,
Ms Suzanne Parsons, Picker Institute
Professor David Challis, University of Europe, April 2010
Manchester, April 2008
Look at
integrated Investigate the
Compare these
care self
Map current experiences
initiatives as management
provision of and
determinants experiences
NHS case expectations
for entry to and
management against the
and exit from expectations
services. availability of
case of older
support
management people
services
10

11. Example research under way
‘Analysis of virtual wards’, ‘Assessing outcomes of integrated care
for people with long term conditions’,
Dr Geraint Lewis, Nuffield Trust Professor Gillian Parker, Uni’ of York
Do 'Virtual How health
Wards' lead and social
care Work with
to changes Develop an
services services to
in use of interactive
have been introduce the
care? cost model
integrated? outcomes
for optimal
required by
What are the configuration
What people with
costs and of Virtual
outcomes do long term
savings of Wards
people with conditions
Virtual
Wards? long term
conditions
want?
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12. What do we mean by impact?
Outputs
(e.g.
Outcomes
papers) (e.g.
guidance)
Research
Need
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Therefore we assess research topics for need BEFORE scientific merit

13. Our theory of change
Environment level: The research pathway
Impact
System level: Adding value to research – avoidable waste
Impact
Based on Chalmers and Glasziou. Avoidable waste in the production and reporting of research evidence. Lancet (2009) vol. 374 (9683) pp. 86-9
13

14. Our ‘needs-led approach’
Needs-led, science-added evidence production
= more important, higher quality,
less waste = higher impact
Patients,
public and the
NHS
at the heart of the
funding process
and funded
projects
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15. The NIHR Health Research System
Faculty
Investigators &
Senior Trainees Associates
Investigators
Universities
Infrastructure Research
NHS Trusts
Clinical Research Research Projects
Networks Patients
& Programmes
&
Public
Clinical Research
Facilities, Centres Research Schools
& Units
Research Research
Governance Information
Systems Systems
15
Systems

16. NETS (Evaluation, Trials and Studies programmes)
Systematic Reviews
programme
Inc.
UK Cochrane Centre
Cochrane Review Groups
Health Services
NETSCC: Established: 2008 CRD
and Delivery Research
Public Health
Established 2012 by Research
merging HSR and SDO
Established: 2008
Health Technology
Assessment Efficacy and Mechanism
Evaluation
Established: 1993 Researcher-led
Funded by the MRC
Managed by NIHR
Commissioned
Funded and managed
by NIHR
Established:
2008 and 2011 16

17. Research funding context
National Institute for Health Research
•£1bn (€1.2bn)/year applied health research system
•UK Department of Health (with contributions from devolved administrations)
Health Services and Deliver Research:
•One of the NIHR’s funding programmes
•Focussed on service delivery, organisation, knowledge transfer, quality, effectiveness
and accessibility of the UK NHS
•For healthcare managers and decision-makers.
Our approach: Adding value to research – reducing avoidable waste
Based on Chalmers and Glasziou. Avoidable waste in the production and reporting of research evidence. Lancet (2009) vol. 374 (9683) pp. 86-9
Impact
Ask the right Answer them
17
questions the right way

18. Who are we – what do we do?
What
National Institute for research do
managers
Health Research
need to
deliver good
£1bn (€1.2bn)/year Health Services and services?
Delivery Research
Applied health programme
research system
C£16m (€19.8m)
for the Focus on quality and
UK’s NHS effectiveness of
healthcare systems
Impact
e.g. better
services
Ask the right Answer them
18
questions the right way

19. Self-care and Case Management
in Long-term Conditions
Professor David Challis, University of Manchester
To identify
To classify by
the extent
observable
To map and nature
features,
current of self-care
different
provision of initiatives
initiatives of
NHS case and to look
integrated
managemen at the role of Final report
care both
t services in these published in
between
primary care initiatives as April 2008
primary and
for people determinants
secondary
with long- for entry to
care, and
term and exit from
between
conditions case
health and
managemen
social care
t services
19

20. Self Management Support among
Older Adults
Ms Suzanne Parsons, Picker Institute Europe
To
To compare
investigate
these against
the self
the
managemen In four
availability of Final report
t geographical
support from published in
experiences areas of
locally based April 2010
and England
services and
expectations
community
of older
resources
people
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21. Analysis of Virtual Wards
Dr Geraint Lewis, Nuffield Trust
To develop
To assess an
To develop
the extent to interactive
an index for
which cost model
determining
integrating where users
To establish the optimal
health and input local
the costs and case load for
social care variables
savings of multi-
services by and the
Virtual Wards disciplinary
means of model
from the case
'Virtual advises the
perspectives managemen
Wards'(VW) user as to
of society, the t that
leads to the optimal
NHS and accounts for
changes in configuration
Local the case-
the use of of Virtual
Government load versus
emergency Wards
quality of
hospital care locally,
care trade-
and social taking into
off
care account
case-mix
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22. Assessing outcomes of integrated
care for people with long term
conditions
Professor Gillian Parker, University of York
To see how
services are
using the
To explore
To explore checklist,
with people To design a
how health whether
with long checklist
and social services
term based on the
care change ways
conditions, outcomes
services of working
what required by
have been with people
outcomes are people with
integrated in with long
wanted from long term
four term
integrated conditions
geographical conditions,
health and for services
areas in whether the
social care to use
England checklist
services
helps people
get what
they need
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23. Identifying the right research questions
Engaging with the research-using community; meeting its needs
Annual stakeholder engagement exercise
•Collect suggestions for research throughout the year
•Present to a wide participatory workshop made up of NHS managers, decision-
makers, organisation representatives, researchers
•Hone down the list of some 50 topics to 20
•Further selection by the prioritisation panel made up of NHS managers,
clinicians, researchers
•Final list of topics forms the research agenda for the HS&DR programme
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24. What happens in practice: work streams
Types of Who defines Frequency
Research the question? Per year
Commissioned Primary research HS&DR 3 calls per year
Commissioned
Evidence synthesis programme (6+ topics)
Researcher-led Primary research Researcher 3 calls per year
Researcher-led
Evidence synthesis
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25. Two stage assessment process
• Health need
• Expressed need
• Sustained interest
• Capacity to generate new knowledge
• Actionable findings and prospects for change
Answering them the right way: assessing the Scientific quality and
appropriateness
•Quality and scientific merit
•Links with knowledge users and where appropriate
•Value for money
•See Tara Lamont presentation…
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