title: Integrated care pilot in north-west London: a mixed methods evaluation.
abstract: BACKGROUND
  This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support.
  
  
  METHODS
  The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study).
  
  
  RESULTS
  The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes.
  
  
  CONCLUSIONS
  Although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. It is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.
authors.affiliation: Health Policy, Nuffield Trust, 59 New Cavendish Street, London, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Curry
authors.forename: Matthew
authors.initials: M
authors.lastname: Harris
authors.forename: Laura H
authors.initials: LH
authors.lastname: Gunn
authors.forename: Yannis
authors.initials: Y
authors.lastname: Pappas
authors.forename: Ian
authors.initials: I
authors.lastname: Blunt
authors.forename: Michael
authors.initials: M
authors.lastname: Soljak
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mastellos
authors.forename: Holly
authors.initials: H
authors.lastname: Holder
authors.forename: Judith
authors.initials: J
authors.lastname: Smith
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Ignatowicz
authors.forename: Felix
authors.initials: F
authors.lastname: Greaves
authors.forename: Athina
authors.initials: A
authors.lastname: Belsi
authors.forename: Nicola
authors.initials: N
authors.lastname: Costin-Davis
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Jones Nielsen
authors.forename: Geva
authors.initials: G
authors.lastname: Greenfield
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cecil
authors.forename: Susan
authors.initials: S
authors.lastname: Patterson
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
keywords: evaluation studies; health care; health services research; integrated health care systems; patient-centred care; reform