title: Multidisciplinary group performance-measuring integration intensity in the context of the North West London Integrated Care Pilot.
abstract: BACKGROUND
  Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot.
  
  
  METHODS
  We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity.
  
  
  RESULTS
  Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described.
  
  
  CONCLUSIONS
  This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, 3 Floor, Reynolds Building, St. Dunstan's Road, Hammersmith, W6 8RP, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Harris
authors.forename: Felix
authors.initials: F
authors.lastname: Greaves
authors.forename: Laura
authors.initials: L
authors.lastname: Gunn
authors.forename: Susan
authors.initials: S
authors.lastname: Patterson
authors.forename: Geva
authors.initials: G
authors.lastname: Greenfield
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.forename: Yannis
authors.initials: Y
authors.lastname: Pappas
keywords: communication; health services; integrated care; multi-disciplinary groups