Journal of Health Services Research & Policy最新文献

{"title":"Staff experiences of training and delivery of remote home monitoring services for patients diagnosed with COVID-19 in England: A mixed-methods study.","authors":"Manbinder Sidhu,&nbsp;Holly Walton,&nbsp;Nadia Crellin,&nbsp;Jo Ellins,&nbsp;Lauren Herlitz,&nbsp;Ian Litchfield,&nbsp;Efthalia Massou,&nbsp;Sonila M Tomini,&nbsp;Cecilia Vindrola-Padros,&nbsp;Naomi J Fulop","doi":"10.1177/13558196231172586","DOIUrl":"https://doi.org/10.1177/13558196231172586","url":null,"abstract":"<p><strong>Objectives: </strong>Remote home monitoring services for patients at risk of rapid deterioration introduced during the COVID-19 pandemic had important implications for the health workforce. This study explored the nature of 'work' that health care staff in England undertook to manage patients with COVID-19 remotely, how they were supported to deliver these new services, and the factors that influenced delivery of COVID-19 remote home monitoring services for staff.</p><p><strong>Methods: </strong>We conducted a rapid mixed-methods evaluation of COVID-19 remote home monitoring services during November 2020 to July 2021 using a cross-sectional survey of a purposive sample of staff involved in delivering the service (clinical leads, frontline delivery staff and those involved in data collection and management) from 28 sites across England. We also conducted interviews with 58 staff in a subsample of 17 sites. Data collection and analysis were carried out in parallel. We used thematic analysis to analyse qualitative data while quantitative survey data were analysed using descriptive statistics.</p><p><strong>Results: </strong>A total of 292 staff responded to the surveys (39% response rate). We found that prior experience of remote monitoring had some, albeit limited benefit for delivering similar services for patients diagnosed with COVID-19. Staff received a range of locally specific training and clinical oversight along with bespoke materials and resources. Staff reported feeling uncertain about using their own judgement and being reliant on seeking clinical oversight. The experience of transitioning from face-to-face to remote service delivery led some frontline delivery staff to reconsider their professional role, as well as their beliefs around their own capabilities. There was a general perception of staff being able to adapt, acquire new skills and knowledge and they demonstrated a commitment to continuity of care for patients, although there were reports of struggling with the increased accountability and responsibility attached to their adapted roles at times.</p><p><strong>Conclusions: </strong>Remote home monitoring models can play an important role in managing a large number of patients for COVID-19 and possibly a range of other conditions. Successful delivery of such service models depends on staff competency and the nature of training received to facilitate effective care and patient engagement.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"171-180"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10300624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9858670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence.","authors":"Catherine Hitch, Paul Toner, Cherie Armour","doi":"10.1177/13558196221149930","DOIUrl":"10.1177/13558196221149930","url":null,"abstract":"<p><strong>Objective: </strong>Research exploring the enablers and barriers that exist for military veterans seeking to address their poor mental health has produced ambiguous results. To identify the enablers and barriers correctly, this study systematically reviews the literature, including research that included alcohol and had a clearly defined veteran population.</p><p><strong>Methods: </strong>Six databases were searched. Inclusion criteria specified that empirical studies related to veterans that had ceased military service and were seeking help for poor mental health and/or alcohol difficulties. Critical Appraisal Skills Programme and AXIS appraisal tools were used to assess quality and bias. A narrative synthesis approach was adopted for analysis. From 2044 studies screened, 12 were included featuring 5501 participants.</p><p><strong>Results: </strong>Forty-four enablers and barriers were identified, with thirty-two being statistically significant. Post-traumatic stress disorder had the greatest number of enabler/barrier endorsements to veterans seeking help. Depression, anxiety, experience and attitudes also acted as enablers/barriers. Most studies were of fair methodological quality. Limitations included that samples were skewed towards US army veterans. Little research exists concerning those that have ceased military service.</p><p><strong>Conclusions: </strong>Veteran help-seeking is likely enabled by poor mental health symptomology and comorbidity, which suggests veterans reach a crisis point before they seek help. Further research on alcohol misuse and attitude formation is required. The field would also benefit from alternative study designs including qualitative studies with non-US participants.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"197-211"},"PeriodicalIF":1.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/72/10.1177_13558196221149930.PMC10363942.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9869707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family physician services and blood pressure control in China: A population-based retrospective cohort study.","authors":"Rize Jing,&nbsp;Karen Eggleston,&nbsp;Xiaozhen Lai,&nbsp;Hai Fang","doi":"10.1177/13558196221149929","DOIUrl":"https://doi.org/10.1177/13558196221149929","url":null,"abstract":"Objective Given the importance of continuous family physician (FP) care in the management of hypertension, we explored the effects of such care among hypertensive patients in China, a country where such care is generally underutilized. We examined the longitudinal association between the use and continuity of FP services and health outcomes including blood pressure (BP) control rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Methods We conducted a population-based cohort study using data from the retrospective regional electronic health record database in Xiamen City, China. The study considered 18,119 hypertensive patients aged over 18 years who had at least two visits to a health center in the preceding 12 months. The generalized estimating equation model was adopted to estimate the longitudinal association between FP service utilization and health outcomes. Results Hypertensive patients treated by their own FPs had a higher BP control rate (OR = 1.14, 95% CI: 1.02–1.28) and lower DBP (−0.36 mmHg, 95% CI: −0.52 to −0.20) than those without a FP or those with a FP but treated by a general community physician (GCP). Compared with hypertensive patients treated exclusively by GCPs, patients treated continuously and exclusively by a FP were 45% more likely to have their BP under control (OR = 1.45, 95% CI: 1.32–1.60), and their SBP and DBP were lower by 0.6 mmHg (95% CI: −0.78 to −0.39) and 0.6 mmHg (95% CI: −0.79 to −0.47), respectively. Conclusions Hypertensive patients continuously treated by their own FPs performed better in terms of BP control rate, SBP and DBP values. In addition, the number and continuity of FP visits were associated with better BP control.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"163-170"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10257739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of knowledge, primary care and community engagement to improve breast-screening access for Pakistani women in the United Kingdom: A secondary analysis of a qualitative study.","authors":"Hooran M Khattak,&nbsp;Victoria G Woof,&nbsp;David P French,&nbsp;Louise S Donnelly,&nbsp;Helen Ruane,&nbsp;Fiona Ulph,&nbsp;Nadeem Qureshi,&nbsp;Nasaim Khan,&nbsp;D Gareth Evans,&nbsp;Kathryn A Robb","doi":"10.1177/13558196231155824","DOIUrl":"https://doi.org/10.1177/13558196231155824","url":null,"abstract":"<p><strong>Objective: </strong>Breast cancer incidence is rising among Pakistani women in the United Kingdom. However, uptake of breast screening remains low. This study aimed to improve access to breast screening for British-Pakistani women by exploring their knowledge of breast cancer and the role of primary care and community networks to support screening access amongst British-Pakistani women.</p><p><strong>Methods: </strong>We undertook a secondary qualitative analysis of 18 semi-structured interviews with British-Pakistani women from East Lancashire in the United Kingdom. Anonymized transcripts of the interviews were used for a thematic analysis.</p><p><strong>Results: </strong>Three themes were identified in the interviewees' responses: (i) 'Women's knowledge of breasts and breast cancer', which described how a cultural taboo exists around Pakistani women's bodies and around breast cancer; (ii) 'Role of primary care', which detailed how General Practitioners can support informed decisions and offer a trusted and valued information source; (iii) 'Community engagement', which described the potential to disseminate breast-screening information through the whole community, including primary care providers, all family members and mosques.</p><p><strong>Conclusions: </strong>Our analysis suggested three main targets for future interventions to improve access to breast screening for British-Pakistani women: (i) co-produced strategies to increase knowledge of breasts and breast screening; (ii) greater collaboration with local General Practitioners to support women to make informed choices about screening; and (iii) community engagement involving General Practitioners and community leaders, to inform everyone - not just screening-age women - about breast cancer and screening.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"149-156"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10363928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9891341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote care - good for some, but not for all?","authors":"Catherine Pope","doi":"10.1177/13558196231172715","DOIUrl":"https://doi.org/10.1177/13558196231172715","url":null,"abstract":"The COVID-19 pandemic fuelled an unprecedented expansion in remote health service delivery globally and employers and governments encouraged people to stay at home to reduce the spread of the virus. In many countries, including the United Kingdom (UK), primary and secondary health care shifted rapidly to ‘remote by default’, with a substantial increase in the use of virtual care such as home monitoring and home based treatment, supported by telephone and online methods to interact with patients and care service users. Remote care has long been advocated, not least by companies that market digital technologies. The promise is convenience and choice: features that many people enjoy in other areas of everyday life, with many government, financial and consumer services moving to digital first, or digital only modalities. As we move from the pandemic, remote care delivery in the UK is becoming a ‘new normal’: the number of telephone appointments in general practice rose from 3.5 million in 2019 to 11.4 million in March 2021. Remote home monitoring or virtual (COVID) wards proliferated during the pandemic, despite a rapid systematic review in 2021 being unable to reach substantive conclusions regarding efficiency, safety or the identification of early deterioration for patients with COVID-19. In the USA, remote patient monitoring increased more than fourfold during the pandemic and the UK has set the ambitious aim to have introduced 40–50 ‘virtual ward beds’ per 100,000 population by December 2023. There is also growing research interest in other forms of remote care such as telephone and online triage and video consulting.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"147-148"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9909028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery.","authors":"Siân Williams,&nbsp;Amanda Barnard,&nbsp;Phil Collis,&nbsp;Jaime Correia de Sousa,&nbsp;Suraj Ghimire,&nbsp;Monsur Habib,&nbsp;Tessa Jelen,&nbsp;Frank Kanniess,&nbsp;Vince Mak,&nbsp;Sonia Martins,&nbsp;Ema Paulino,&nbsp;Hilary Pinnock,&nbsp;Miguel Roman,&nbsp;Hanna Sandelowsky,&nbsp;Ioanna Tsiligianni,&nbsp;Laurine van der Steen,&nbsp;Fabio Weber Donatelli","doi":"10.1177/13558196221140318","DOIUrl":"https://doi.org/10.1177/13558196221140318","url":null,"abstract":"<p><p>The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"181-189"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/0a/10.1177_13558196221140318.PMC10363957.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9874883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using arts-based research in applied health care: An example from an evaluation of NHS dental contract reform in Wales.","authors":"Ellie Overs,&nbsp;Chris Woods,&nbsp;Lynne Williams,&nbsp;Sion Williams,&nbsp;Chris Burton,&nbsp;Lorelei Jones,&nbsp;Paul R Brocklehurst","doi":"10.1177/13558196221137202","DOIUrl":"https://doi.org/10.1177/13558196221137202","url":null,"abstract":"<p><strong>Objective: </strong>Arts-based research (ABR) refers to the use of art in the research process to help generate, interpret and/or communicate knowledge. We used ABR principles to adapt a centre-staging method to complement a more traditional qualitative approach to evaluate participants' views on dental service reform.</p><p><strong>Methods: </strong>We asked five individuals in the dental health sector in the National Health Service in Wales to select objects to depict their views on the current reform process and their ideal reform process. This process took place alongside traditional semi-structured interviews with the participants.</p><p><strong>Results: </strong>There were three marked differences in the centre-staging process as compared to the interviews: (1) there was a greater use of symbolism by the participants, (2) the participants put a greater focus on the process of change and (3) the participants were more likely to reveal the emotions underlying their assessments of the reform process.</p><p><strong>Conclusions: </strong>The arts-based approach adopted appeared to be highly accessible and has the potential to be used in a wide range of applications.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 3","pages":"190-196"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10257716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health emergencies attended by ambulances in the United Kingdom and the implications for health service delivery: A cross-sectional study.","authors":"Harriet Elizabeth Moore,&nbsp;Aloysius Niroshan Siriwardena,&nbsp;Mark Gussy,&nbsp;Robert Spaight","doi":"10.1177/13558196221119913","DOIUrl":"https://doi.org/10.1177/13558196221119913","url":null,"abstract":"<p><strong>Objective: </strong>In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 '999' calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome).</p><p><strong>Results: </strong>A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, <i>p</i> < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than 'Treated and transported' were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene.</p><p><strong>Conclusions: </strong>Drawing on the expertise of mental health specialists may help '999' dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 2","pages":"138-146"},"PeriodicalIF":2.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/23/10.1177_13558196221119913.PMC10061621.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10025904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic.","authors":"Alison Duncan, Carolina-Nicole Herrera, Margaret Okobi, Shurobhi Nandi, Rachel Oblath","doi":"10.1177/13558196221135119","DOIUrl":"10.1177/13558196221135119","url":null,"abstract":"<p><strong>Objective: </strong>To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8 months of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34 weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition.</p><p><strong>Results: </strong>Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (β = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], <i>p</i> < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], <i>p</i> < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], <i>p</i> < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year.</p><p><strong>Conclusions: </strong>The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 2","pages":"80-88"},"PeriodicalIF":1.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9732494/pdf/10.1177_13558196221135119.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10025950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scale and spread of innovation in health and social care: Insights from the evaluation of the New Care Model/Vanguard programme in England.","authors":"Julie MacInnes,&nbsp;Jenny Billings,&nbsp;Anna Coleman,&nbsp;Rasa Mikelyte,&nbsp;Sarah Croke,&nbsp;Pauline Allen,&nbsp;Kath Checkland","doi":"10.1177/13558196221139548","DOIUrl":"https://doi.org/10.1177/13558196221139548","url":null,"abstract":"<p><strong>Objective: </strong>Little is known about how to achieve scale and spread beyond the early local adoption of an innovative health care programme. We use the New Care Model - or 'Vanguard' - programme in the English National Health Service to illuminate the process, assessing why only one of five Vanguard programmes was successfully scaled up.</p><p><strong>Methods: </strong>We interviewed a wide range of stakeholders involved in the Vanguard programme, including programme leads, provider organisations, and policymakers. We also consulted relevant documentation.</p><p><strong>Results: </strong>A lack of direction near the end of the Vanguard programme, a lack of ongoing resources, and limited success in providing real-time monitoring and evaluation may all have contributed to the failure to scale and spread most of the Vanguard models.</p><p><strong>Conclusions: </strong>This programme is an example of the 'scale and spread paradox', in which localism was a key factor influencing the successful implementation of the Vanguards but ultimately limited their scale and spread.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 2","pages":"128-137"},"PeriodicalIF":2.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9669761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}