Multidisciplinary integration in the context of integrated care – results from the North West London Integrated Care Pilot
DOI:
https://doi.org/10.5334/ijic.1146Keywords:
multidisciplinary, communication, primary careAbstract
Background: In the context of integrated care, Multidisciplinary Group (MDG) meetings involve participants from diverse professional groups and organizations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to evaluate the effectiveness of MDGs by measuring the extent to which participants integrate within MDG meetings and whether this integration leads to improved working.
Methods: We purposively selected four MDG meetings, and conducted a content analysis of audio-recorded and transcribed case discussions. Two coders independently coded utterances according to their ‘integrative intensity’ which was defined against three a priori independent domains – the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standardized weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how integrative intensity changed during the conversations.
Results: Twenty-three Case Discussions in four different MDG groups were transcribed and coded. Inter- and intra-rater reliability was good as shown by the Prevalence and Bias Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; Presenting GP 38.75%; Chair 7.8%; Non-Presenting GP 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrative intensity; however there was a gradual increase (R2=0.66) in integrative intensity during the Case Discussions. Based on analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward.
Interpretation: We characterize the MDGs as having consultative characteristics with some trend towards collaboration, but that best resemble Community-Based Ward Rounds. Although integration scores do increase from the beginning to the end of the case discussions this does not tend to translate into actions for the groups to take forward. The role of the Chair and the improved participation of non-presenting GPs and Allied Health Professionals seem important; particularly given the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the MDGs. This suggests that more could be done to sensitize participants to the value of full participation from all members of the group. The method we have developed could be used for ongoing and future evaluations of integrated care projects.
Published
Issue
Section
License
Copyright (c) 2013 The Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors
Starting in 2009 the International Journal of Integrated Care applies the Creative Commons Attribution 4.0 Internaltional License (CC-BY, http://creativecommons.org/licenses/by/4.0/) to all articles, submitted in or after January 2009, that are published in IJIC. Authors retain ownership of the copyright for their articles, but they permit anyone unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. After it has appeared in IJIC authors may republish their text in any way they wish (electronic or print) as long as they clearly acknowledge IJIC as its original publisher with the correct citation details and copyright notice, independent of whether the article is used in whole or in part.
- Authors of accepted manuscripts assign IJIC the right to publish and distribute their text electronically and to archive it permanently retrievable electronically.
- Authors retain the copyright of the article. After it has appeared in IJIC authors may republish their text in any way they wish (electronic or print) as long as they clearly acknowledge IJIC as its original publisher with the correct citation details and copyright notice (see below), independent whether the article is used in whole or in part.
- IJIC may change the appearance of the article, both layout and technical format, to ensure consistency and readability. Under no circumstance will the content of the article be altered.
- The author warrants to IJIC that the article is original, does not infringe any existing copyright, and does not infringe the rights of any third party. This warrant concerns the entire manuscript, text as well as pictures, sound, video, data sets etc. The author also warrants to us that he has full authority to enter into this agreement and that the rights he is granting to IJIC are done so without breaching any obligations he may have.
- Acceptation:
Readers
Starting 2009 Utrecht the International Journal of Integrated Care applies the Creative Commons Attribution 4.0 International License (CC-by) to all articles, submitted in or after January 2009, that are published in the IJIC. Under the CC-by, authors retain ownership of the copyright for their article, but authors allow anyone unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. No permission is required from the authors or the publishers.
- Persons using http://www.ijic.org may view, reproduce or store copies of articles of the journal provided that they are used only for their personal, non-commercial use (especially for educational purposes). Articles with the CC-by logo are published under the CC-by license and can be used without restrictions, provided the article is properly cited. Any uses or copies of this Journal in whole or in part must include the citation details and copyright notice (see below) of IJIC. The URL (= uniform resource locator) of a document in IJIC (from this server) may be used in another electronic document freely.
- Linking: IJIC encourages and appreciates links in your own Web pages to IJIC-webpages. Permission is expressly granted to any person who wishes to place a link in his or her own Web page to IJIC's homepage http://www.ijic.org. As a courtesy, if you link to, or include IJIC in an index, please let us know.
- Privacy statement: On the IJIC site we may collect some anonymous information about you when you visit this site. IJIC may also include information for its own use about your visit in collective or aggregated data that does not identify you specifically.
Citation details and copyright notice
When referring to International Journal of Integrated Care either for re-publication by the author or permitted usage by third parties, the following information should be added:
Citation details:
Customary bibliographic citation, including author name(s), volume number and date of publication, article title, International Journal of Integrated Care (or abbreviation Int J of Integr Care), and the DOI (for instance http://doi.org/10.5334/sta.433).
Copyright notice for papers submitted in or after January 2009: "This work is licensed under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited "
Copyright notice for papers submitted in or before 2008:
"Readers are reminded that this work is protected by copyright. While they are free to use the ideas expressed in it, they are not allowed to copy, distribute or publish the work or part of it, in any form, printed, electronic or otherwise, except for reasonable quoting, clearly indicating the source. Readers are permitted to make copies, electronically or printed, for non-commercial use, particularly personal or classroom use."
The authors retain copyright of their article.