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Risk-profiling arrangements have not reduced emergency admissions, study finds

Case management arrangements have not led to any significant reduction in emergency admissions, a report on a large-scale pilot programme has concluded.

The report, from the Nuffield Trust and Imperial College London, comes as the Government has begun implementing its risk-profiling DES, which incentivises GPs to identify patients most at risk of emergency admissions.

But the evaluation of the first year of the Inner North West London Integrated Care pilot programme – which focused on developing new models of care planning and coordination for people with diabetes and those who are over 75 years of age – showed no significant reduction in emergency admissions or significant changes in the wider use of services.

The report said: ‘Analysis of the first tranche of patients treated under the new case management arrangements did not show any significant reduction in emergency admissions – but we recognise that it is probably too early for definitive conclusions.

‘The evaluation was able to identify person-level matched controls for 1,236 of the first patients recruited, and monitored a range of measures of service use during the first three months of each patient’s intervention. This analysis found there were no significant differences from the matched control patients during this period.’

Dr Judith Smith, director of policy at the Nuffield Trust said: ‘The benchmarks set in this first evaluation report provide a sound basis for the pilot to assess its progress against, particularly in relation to activity, cost, and health outcomes. International evidence points to the fact that integrated care takes years to develop, and a minimum of three to five years is needed for such initiatives to show impact in relation to activity, patient experience and outcomes.’

This report comes after one of the architects of the QOF scheme, Professor Martin Roland, chair in health services research at the University of Cambridge, told Pulse that risk profiling had not reduced emergency admissions in practice.

He said: ‘The reality of this is that this doesn’t seem to have worked in practice and there have been a number of valuations that seem to suggest not only that intensive case management of people might not reduce admissions but the most recent evaluation suggested that admissions might actually increase from the additional attention that intensive case management will bring. So there is not much evidence at the moment that risk-profiling reduces emergency admissions.’