Article Text

Download PDFPDF

Effect of an integrated care pathway on use of primary and secondary healthcare by patients at high risk of emergency inpatient admission: a matched control cohort study in Tower Hamlets
  1. Will Parry1,
  2. Arne Timon Wolters2,
  3. Richard James Brine2,
  4. Adam Steventon2
  1. 1 Dr Will Parry Ltd, London, UK
  2. 2 The Health Foundation, London, UK
  1. Correspondence to Dr Adam Steventon; adam.steventon{at}


Objectives To assess the effects of an integrated care pathway on the use of primary and secondary healthcare by patients at high risk of emergency inpatient admission.

Design Observational study of a real-life deployment of integrated care, using patient-level administrative data. Regression analysis was used to compare integrated care patients with matched controls.

Setting A deprived, inner city London borough (Tower Hamlets).

Participants 1720 patients aged 50+ years registered with a general practitioner in Tower Hamlets and at high risk of emergency inpatient admission enrolled onto integrated care during 2014. These patients were matched to control patients, also selected from Tower Hamlets, with respect to demographics, diagnoses of health conditions, previous hospital use and risk score.

Interventions Enrolled patients were eligible for a range of interventions, such as case management, support with self-care and enhanced care coordination. Control patients received usual care.

Primary and secondary endpoints Number of emergency inpatient admissions in the year after enrolment onto integrated care. Secondary endpoints included numbers of elective inpatient admissions, inpatient bed days, accident and emergency attendances, outpatient attendances and general practitioner contacts in the year after enrolment.

Results There was no evidence that the integrated care pathway reduced patients’ healthcare utilisation in the first year post-enrolment. Matched controls and integrated care patients were similar at baseline. Following enrolment, integrated care patients were more likely than matched controls to experience elective inpatient admissions (adjusted incidence rate ratio (IRR)=1.27, 95% CI 1.08 to 1.49, p=0.004). They were also more likely to experience general practitioner contacts (adjusted IRR=1.11, 95% CI 1.06 to 1.16, p<0.001), but other endpoints were not significantly different between the groups.

Conclusions The integrated care pathway was not associated with a reduction in healthcare utilisation in the first year, but appeared to have increased elective inpatient admissions and general practitioner workload.

  • primary care
  • preventive medicine
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors AS and ATW designed the original study protocol. ATW liaised with the programme about participant data and organised the data linkage. RJB undertook additional data preparation and manipulation. WP performed the analysis. WP prepared the manuscript. AS reviewed the manuscript. AS was the study guarantor and confirms that this paper is an accurate representation of the study findings. The named authors conducted this study independently of Tower Hamlets CCG and NEL CSU; the authors were solely responsible for the decision to submit this manuscript for publication.

  • Funding The study was funded by The Health Foundation. Registered charity number 286967.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available. The data used in this study comprise highly sensitive health records of individual patients, with a high risk of identifiability. As such, they are stored in a highly secure data environment and are not available for sharing.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.