Assessing Integrated Care for Respiratory Diseases

Chronic respiratory disease (CRD) is a serious health issue in the UK. About 15% of people have some type of CRD, making it a major cause of illness and death. Among various diseases, CRD ranks as the fourth leading cause of death in England. Certain groups, particularly those with less income or poorer living conditions, are more likely to suffer from these diseases due to factors like smoking, air pollution, bad housing, and job-related risks.

The healthcare system bears a heavy cost because of CRD, with around £4.7 billion spent on treating asthma and chronic obstructive pulmonary disease (COPD). This burden may grow as the population ages, leading to questions on how to improve respiratory services for better care.

#Integrated Care in the NHS

To improve respiratory health, the NHS has made it a priority to promote integrated care. Integrated care means bringing together services in a way that makes care smoother and more efficient for patients. This approach is thought to be essential for a sustainable healthcare system. Without integration, patients may miss out on important services, leading to delays and extra costs.

Despite efforts to create integrated care systems across England in recent years, evaluations of these systems have shown mixed results. Research indicates that part of the problem lies in the difficulty of choosing the right measures to evaluate the success of these complex systems. Additionally, access to data poses challenges, especially in primary and community care, which can limit the ability to evaluate these systems accurately.

#Focus on Morecambe Bay

The North-West region of England has a particularly high mortality rate from Respiratory Diseases, with 44.7% of deaths in people under 75 years attributed to these issues. Although clinical commissioning groups were dissolved in July 2022, they previously played a crucial role in planning healthcare services in their local areas. The Morecambe Bay Clinical Commissioning Group (MBCCG) served a population of around 352,000 across various communities, including both urban and rural areas with diverse socio-economic backgrounds.

The Morecambe Bay Respiratory Network (MBRN) is an integrated care system that aims to improve healthcare delivery for patients with the most common CRDs in the UK, specifically asthma, COPD, bronchiectasis, and interstitial lung disease (ILD). The initiative began in 2017, initially reaching half of the MBCCG's population, and expanded to 65% by 2019. This paper primarily focuses on the first phase of the initiative.

The MBRN includes an enhanced Primary Care team that can directly access specialist investigations and is supported by secondary care through monthly meetings involving various healthcare professionals. This system promotes clear communication and coordinated care across different levels of healthcare, ensuring that patients receive consistent information and reducing unnecessary appointments.

A key measure for the MBRN is the impact on OutpatientReferrals. A decline in these referrals indicates improved service efficiency, closer care for patients, and reduced costs.

#The Impact of COVID-19

Every year, the NHS conducts about 125 million outpatient appointments. The COVID-19 pandemic has put even more pressure on an already stretched system. The number of people waiting for elective care has increased substantially since the pandemic began, and the waiting list continues to grow as those who delayed their care during this time come forward for treatment.

To manage this demand effectively, transforming elective care is necessary. Better collaboration with general practice (GP) is essential to streamline patient pathways, reducing the need for referrals and delays wherever possible.

#Purpose of the Research

The goal of this research is to assess the MBRN's impact using data that has not been widely utilized in health service studies. The focus will be on referral rates to outpatient respiratory clinics, while also accounting for demographic factors and changes in CRD patient numbers. A unique aspect of this analysis is looking at referral patterns in small geographic areas, unlike other studies that typically examine broader levels.

The investigation will follow a specified structure: after a brief overview of the modeling approach, the study will describe the data source and its complexities, followed by the proposed methodology. Finally, results will be presented, leading to a discussion on the MBRN’s impact and the need for reliable data in healthcare evaluations.

#The Data Used in the Study

This research utilizes NHS data collected in the Morecambe Bay Community Data Warehouse (CDW), a database managed by the University Hospitals of Morecambe Bay NHS Foundation Trust. The CDW consolidates data from various healthcare services in the area, allowing for individual-level linkage of records.

Referrals were identified from the records of the three hospitals providing outpatient respiratory services in the region. A referral is considered relevant if it involves a new request from a GP for respiratory-related clinics for adult patients living in the area. Certain referrals, such as those linked to asthma biologics or specific treatment pathways for suspected cancer, were excluded from the analysis.

The research also built a dataset of GP-registered adults in the study area, using entry dates based on GP registration and age. Some patients’ registration details are incomplete, especially for those who have left the GP or passed away. The research accounted for these gaps by using the last recorded interaction with primary care as a proxy.

CRD patients were identified based on recorded diagnoses in primary care. To maintain accuracy, the study applied criteria aligning with MBRN’s patient registers, such as requiring recent asthma treatment.

The CDW has limitations, including missing data for some GP records, meaning that these gaps could affect the population count of registered patients and, consequently, the analysis results.

#Secondary Data Sources

To estimate a more accurate GP-registered population, data from NHS Digital was utilized, which releases quarterly patient counts by location. The Office for National Statistics (ONS) provides mid-year population estimates that informed demographic information for the analysis. The study also calculated distances to healthcare facilities to incorporate travel time into the study.

#Analyzing Referral Rates

The analysis focuses on the rate of referrals from GPs to outpatient respiratory clinics over eight years. This research uses various statistical methods to analyze the data while considering the unique challenges posed by the data's complexities.

#Observations on Patient Count Adjustment

To provide a better estimate of the number of CRD patients, the study adjusted for known data issues from the CDW. Through a modeling approach, researchers aim to estimate the unobserved population accurately.

#Referrals to Outpatient Clinics

The number of referrals to respiratory outpatient clinics was tracked throughout the study period, with specific attention paid to changes over time. Initial data showed an increase in referrals until 2016, but post-MBRN years did not exceed those 2016 levels.

#Model Output Summary

The findings from the models indicated various factors influencing referral rates. Factors like age, distance to the nearest hospital, and COPD prevalence were significant. The data showed that areas with more significant MBRN intervention saw a substantial decrease in referral rates, indicating that integrated care may effectively reduce the need for outpatient referrals.

#The Results of the Research

The research indicated a clear relationship between MBRN coverage and the rate of referrals. Areas with less intervention had higher referral rates compared to those receiving higher MBRN coverage, especially in 2018 and 2019.

The research highlights the importance of integrated care in managing chronic respiratory diseases and suggests that improvements in primary care can alleviate some pressures on outpatient services.

#Conclusions

The analysis demonstrates that integrated care initiatives like the MBRN can effectively reduce outpatient referrals. This can lead to more efficient healthcare delivery and potentially improve patient pathways.

In summary, the study emphasizes the value of using routinely collected healthcare data in evaluating integrated care initiatives. The findings may be useful for policymakers in designing effective strategies to manage chronic respiratory diseases and optimize healthcare resources.

Future research should continue to assess the impact of integrated care on patient outcomes, providing deeper insight into care delivery for respiratory diseases. Additionally, attention should be given to developing robust evaluation frameworks that can address the challenges of using routinely collected data effectively.

Overall, the MBRN presents a promising model for integrated care, showcasing how collaborative efforts can lead to better healthcare experiences for patients.