Rand Research on the Benefits of Integrated Care.

A new Rand research brief reports on the results of 16 pilot projects in England to explore greater use integrated care.   (Rand Paper)    There were a variety of approaches to integrated care and a variety of target populations, which makes discerning which features may have or have not worked more difficult, but there was a focus on the elderly, who often have complex care needs.  Most of the pilots focused on horizontal integration of local care as opposed to integration of hospital and ambulatory care.  Most staff were enthusiastic about the pilots, often because it made their jobs more interesting, and not surprisingly, also believed that the pilots improved care.  While many felt that coordination and communication had become better, many also thought it was too early to tell how much impact their really was.  On the other hand, patients were not enthusiastic about the newly integrated care experience.  Patients felt they were less likely to be involved in decisions or to be able to see a provider of their choice.  In terms of more concrete outcomes, there was an overall 4% decline in elective hospital admissions and a 20% one in outpatient visits.  Emergency admissions actually rose by a small 2%.  Somewhat better results were reported in the more intensive case management sites.  There was no overall reduction in spending, particularly when considering the costs of the interventions.   So one might come to an initial conclusion that better integrated care, at least via these pilots, did not save money and may or may not have improved objectively measured quality.