Article Text

Download PDFPDF

Children and Young People’s Health Partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use
  1. James Joseph Newham1,
  2. Julia Forman1,
  3. Michelle Heys2,
  4. Simon Cousens3,
  5. Claire Lemer4,
  6. Mohamed Elsherbiny5,
  7. Rose-Marie Satherley1,
  8. Raghu Lingam6,
  9. Ingrid Wolfe1
  1. 1 Department of Women & Children’s Health, King’s College London, London, UK
  2. 2 Institute for Global Health, London, UK
  3. 3 Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Guy’s Hospital, London, UK
  5. 5 Department of Population Health Sciences, King’s College London, London, UK
  6. 6 School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
  1. Correspondence to Dr James Joseph Newham; james.newham{at}kcl.ac.uk

Abstract

Introduction Children and young people (CYP) in many high-income settings have poor healthcare outcomes, especially those with long-term conditions (LTCs). Emergency and outpatient hospital service use is increasing unsustainably. To address these problems, the Children and Young People’s Health Partnership (CYPHP) has developed and is evaluating an integrated model of care as part of a health systems strengthening programme across two boroughs of London, UK that are characterised by mixed ethnic populations and varying levels of deprivation. The CYPHP Evelina London model of care comprises proactive case-finding and triage, specialist clinics and transformative education and training for professionals working with CYP. Services are delivered by multidisciplinary health teams with an emphasis on increased coordination across primary, community and hospital settings and integration of physical and mental healthcare that accounts for the CYP’s social context.

Methods and analysis The phased roll out of the CYPHP Evelina London model allows an opportunistic population-based evaluation using a cluster randomised controlled trial design. Seventy general practices across two London boroughs, grouped into 23 clusters, were randomised to provide either the CYPHP model of care (n=11) or enhanced usual care (n=12).

The evaluation will measure the impact of the CYPHP Evelina London model of care on child and parent health and well-being, healthcare quality and health service use up to 2 years postimplementation. A population-level evaluation will use routinely collected pseudonymised healthcare data to conduct a service-use analysis for all CYP registered with a participating general practice (n=~90 000) with the rate of non-elective admissions as the primary outcome. We will seek consent from a subset of this population, with specific conditions (target n=2138) to assess the impact on patient-reported outcomes using the Paediatric Quality of Life Inventory (PedsQL) and Warwick-Edinburgh Mental Well-Being Scale (WEBWMS) as, respectively, the child- and parent-related primary outcomes.

Ethics and dissemination Ethics approval obtained from South West-Cornwall & Plymouth Research Ethics Committee. Results will be submitted for publication in peer-reviewed journals. Findings will be generalisable to community-based models of care, especially in urban settings. Our process evaluation will identify barriers and enablers of implementation and delivery of care salient to the context and condition.

Trial registration number NCT03461848; Pre-results.

  • child health
  • integrated care
  • cluster randomised controlled trial

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: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

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.

Footnotes

  • JJN and JF are joint first authors.

  • 36 RL and IW are joint last authors.

  • Contributors JJN was responsible for writing the first draft of the protocol and JF was responsible for drafting the second version (joint first authorship). JJN, JF, MH, SC, CL, ME, R-MS, RL, IW were involved in the study design and in obtaining ethical approvals. RL and IW were responsible for study conception (joint last authorship). All authors commented on the manuscript and agreed with the final version.

  • Funding This work was supported by Guy’s and St Thomas’ Charity.

  • Competing interests None declared.

  • Ethics approval This study was approved by South West-Cornwall & Plymouth Research Ethics Committee and the NHS Health Research Authority on 14 December 2017.

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

  • Patient consent for publication Not required.

Linked Articles