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Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot.

Harris M, Greaves F, Gunn L, Patterson S, Greenfield G, Car J, Majeed A, Pappas Y - Int J Integr Care (2013)

Bottom Line: We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working.The role of the Chair and the improved participation of non-presenting general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores.The method we have developed could be used for ongoing and future evaluations of integrated care projects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Public Health, Department of Primary Care and Public Health, Imperial College London, 3rd Floor, Reynolds Building, St Dunstan's Road, Hammersmith, London W6 8RP, UK.

ABSTRACT

Background: In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working.

Methods: We purposively selected four Multidisciplinary Group 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. Standardised 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 Multidisciplinary 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 general practitioner 38.75%; Chair 7.8%; non-presenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrative intensity; however, there was a gradual increase (R (2) = 0.71) in integrative intensity during the Case Discussions. Based on the analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward.

Interpretation: We characterise the Multidisciplinary Groups 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 general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the Multidisciplinary Groups. This suggests that more could be done to sensitise participants to the value of full participation from all the members of the group. The method we have developed could be used for ongoing and future evaluations of integrated care projects.

No MeSH data available.


Distribution of utterances (%) per participant type and MDG (For all MDGs Consultants = 2, PGP = 1, Chair = 1; For MDG 1 NGP = 6, MDG 2 NGP = 4, MDG 3 NGP = 3 and MDG 4 NGP = 4; For MDG 1 Allied = 3, MDG 2 Allied = 3, MDG 3 Allied = 5, MDG 4 Allied = 2). MDG, Multidisciplinary Group; NGP, non-presenting general practitioner.
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fg001: Distribution of utterances (%) per participant type and MDG (For all MDGs Consultants = 2, PGP = 1, Chair = 1; For MDG 1 NGP = 6, MDG 2 NGP = 4, MDG 3 NGP = 3 and MDG 4 NGP = 4; For MDG 1 Allied = 3, MDG 2 Allied = 3, MDG 3 Allied = 5, MDG 4 Allied = 2). MDG, Multidisciplinary Group; NGP, non-presenting general practitioner.

Mentions: The four observed Multidisciplinary Groups (one Diabetes and three Elderly care) meetings encompassed 23 Case Discussions and over seven hours of discussion. The number of people attending the Multidisciplinary Group meetings ranged from 11 to 15 (mean 14). Recordings yielded 4209 utterances, with a mean of 183 (Standard deviation 98.8) utterances per Case Discussion. Each utterance was coded three times - Level, Valence and Focus - corresponding to around 400 pages of verbatim discussion. Only 6.9% of all utterances could not be coded and this did not vary significantly by Case Discussion or Multidisciplinary Group. Because numbers of general practitioners and Allied Health Professionals present in Multidisciplinary Groups varied, we calculated the utterance rate per participant type to enable comparison (Figure 1). In Multidisciplinary Group 4, the Multidisciplinary Group coordinator acted as the Chair as the usual general practitioner was not present. As less than 0.5% of all the utterances were made by the Multidisciplinary Group coordinators in the other Multidisciplinary Groups, we excluded these from the analysis. Case Discussions were all dominated by the Consultants and the presenting general practitioners, with little involvement from general practitioners not presenting the case or other attendees. There was no significant difference in this pattern across the four Multidisciplinary Groups.


Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot.

Harris M, Greaves F, Gunn L, Patterson S, Greenfield G, Car J, Majeed A, Pappas Y - Int J Integr Care (2013)

Distribution of utterances (%) per participant type and MDG (For all MDGs Consultants = 2, PGP = 1, Chair = 1; For MDG 1 NGP = 6, MDG 2 NGP = 4, MDG 3 NGP = 3 and MDG 4 NGP = 4; For MDG 1 Allied = 3, MDG 2 Allied = 3, MDG 3 Allied = 5, MDG 4 Allied = 2). MDG, Multidisciplinary Group; NGP, non-presenting general practitioner.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3817952&req=5

fg001: Distribution of utterances (%) per participant type and MDG (For all MDGs Consultants = 2, PGP = 1, Chair = 1; For MDG 1 NGP = 6, MDG 2 NGP = 4, MDG 3 NGP = 3 and MDG 4 NGP = 4; For MDG 1 Allied = 3, MDG 2 Allied = 3, MDG 3 Allied = 5, MDG 4 Allied = 2). MDG, Multidisciplinary Group; NGP, non-presenting general practitioner.
Mentions: The four observed Multidisciplinary Groups (one Diabetes and three Elderly care) meetings encompassed 23 Case Discussions and over seven hours of discussion. The number of people attending the Multidisciplinary Group meetings ranged from 11 to 15 (mean 14). Recordings yielded 4209 utterances, with a mean of 183 (Standard deviation 98.8) utterances per Case Discussion. Each utterance was coded three times - Level, Valence and Focus - corresponding to around 400 pages of verbatim discussion. Only 6.9% of all utterances could not be coded and this did not vary significantly by Case Discussion or Multidisciplinary Group. Because numbers of general practitioners and Allied Health Professionals present in Multidisciplinary Groups varied, we calculated the utterance rate per participant type to enable comparison (Figure 1). In Multidisciplinary Group 4, the Multidisciplinary Group coordinator acted as the Chair as the usual general practitioner was not present. As less than 0.5% of all the utterances were made by the Multidisciplinary Group coordinators in the other Multidisciplinary Groups, we excluded these from the analysis. Case Discussions were all dominated by the Consultants and the presenting general practitioners, with little involvement from general practitioners not presenting the case or other attendees. There was no significant difference in this pattern across the four Multidisciplinary Groups.

Bottom Line: We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working.The role of the Chair and the improved participation of non-presenting general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores.The method we have developed could be used for ongoing and future evaluations of integrated care projects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Public Health, Department of Primary Care and Public Health, Imperial College London, 3rd Floor, Reynolds Building, St Dunstan's Road, Hammersmith, London W6 8RP, UK.

ABSTRACT

Background: In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working.

Methods: We purposively selected four Multidisciplinary Group 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. Standardised 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 Multidisciplinary 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 general practitioner 38.75%; Chair 7.8%; non-presenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrative intensity; however, there was a gradual increase (R (2) = 0.71) in integrative intensity during the Case Discussions. Based on the analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward.

Interpretation: We characterise the Multidisciplinary Groups 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 general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the Multidisciplinary Groups. This suggests that more could be done to sensitise participants to the value of full participation from all the members of the group. The method we have developed could be used for ongoing and future evaluations of integrated care projects.

No MeSH data available.