PONE-D-24-19911Research-informed decision-making for empowering integrated care system development: Co-creating innovative solutions to facilitate enhanced service provisionPLOS ONE

Dear Dr. Demir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. 

Please submit your revised manuscript by Aug 12 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Reindolf Anokye

Academic Editor

PLOS ONE

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Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:  I would like to thank the authors for the possibility to read the paper.

I think that the topic is very interesting and that could become very appreciate both by the academic community and the practitioners.

Considering the valuable topics, I have some comments for the authors to improve their study.

• Introduction.

The introduction is very long and rich of topics, insights, literature references and comments. I think that this could derive from the objective of the study and could cause difficulties during the papers’ reading. For this reason, I could that could be better to provide an overview of the issue, considering the background and providing relevant examples, able also to describe and highlight the literature gaps or the possible practical contributions of the study, and then defining a paragraph of literature review for the collection of the already published evidence related to the Integrated Care Management model, enlarging the already defined paragraph about ICM in the UK, not presenting only the Policy and the Practice but presenting also the literature evidence about the topic.

In addition, in the Introduction, the systems approach is presented and described but this part of the manuscript is not well linked to the first part of the introduction, providing some issues for the reader, in terms of knowledge and contents’ flow.

Also, the concept of decision support tool (DST) could be better introduced and presented, if relevant from the beginning.

Moreover, the Table 1, presenting some questions on how OR could achieve enhanced ICM in a hospital setting, is not so clear. Are these the research questions of the papers? Or these are some guideline questions?

• Literature Review.

In this paragraph, I think that a summary Table could help the reader to focus on the different proposed alternatives.

• Materials and Methods.

- More references may be introduced to present and justify the methodological approach and research rigour.

- In the section of System Modelling, more details may be provided with reference to the conducted meetings and the focus group.

- The section devoted to Data Collection and Analysis is general and it is difficult to understand which dataset and information are used for the study as well as how the authors collected the data.

• Case Study: Application of the Model to an NHS Hospital.

The data included in the Table 2 might be moved into the Materials or could be better to clarify that this is the materials and methods section dedicated to the case, and then presenting the results.

It is not clear for my point of view, how the authors collected the data and which is the data source(s).

• Results

I think that it could be better to move the scenarios’ definition and description into the methodological section.

• Discussion

This section may be devoted to discuss the achieved results, and the methodological approach applied, in comparison with already published papers and reference, in order to explain the position.

In addition, the practical implications and the tool’s advantages for the KOL are well presented and structured, while the theoretical implications are lacking and might be presented.

Good luck for the study and for the publication!!

Reviewer #2:  Thank you, I enjoyed reading your manuscript. I think it is publishable, subjective to some corrections.

The study provides a valuable contribution to the field of integrated care system in healthcare delivery. However, the manuscript could be improved by enhancing the critical analysis in the literature review and discussion sections, and by ensuring conciseness and clarity throughout. In the Word document, I highlighted the areas that might benefits of some improvements.

- The introduction was well written and effectively sets the context by discussing global healthcare challenges and the importance of integrated care. However, it could be more concise. Some sections, like the NHS's history, could be shortened to maintain reader engagement.

- The literature review nicely links the theoretical framework to practical applications in healthcare, providing relevant examples and citations, but it could benefit from a more critical analysis and a better synthesis of the literature.

- Although the results section provides a thorough analysis of the impact of interventions on activity, resource utilisation, costs, and revenues, you could discuss the implications of the results here, linking back to yourstudy's objectives and pertinent literature.

- The discussion part highlights the practical impact of the DST on decision-making and service provision in the NHS. However, a more critical perspective is needed to address potential limitations and challenges in implementing the proposed interventions. It would also be useful to discuss the generalisability of the findings to other healthcare settings or countries with similar healthcare systems.

Well done again and fingers crossed you will have it publish soon.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

**********

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PONE-D-24-19911R1Research-informed decision-making for empowering integrated care system development: Co-creating innovative solutions to facilitate enhanced service provisionPLOS ONE

Dear Dr. Demir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

In addition to the specific comments, please pay attention to the general comments by reviewers below

Reviewer 1

The paragraph "ICM in the UK: Policy and Practice" is well conceived, but I think that this paragraph is not so connected with the other introductive sections, and this should be a problem for the paper's readiness. Why do you not think to introduce the concepts and the topics of this paragraph in the first part of the Introduction and then maintain the section of the Literature review?

Table 1 allows one to clarify better the role of the proposed questions in light of the background provided but anyway, I think that also one or two more precise research question(s) for the paper, connected with the objective defined by the authors, should be proposed to help the reader understanding all the paper

Considering that the authors stated in the methodological section that semi-structured interviews and focus groups were conducted, I think that some details regarding the questions posed or the information/areas investigated should help.

Another important point that I think is missing also in this updated version of the paper is related to the comparison of the presented study with other already published evidence. How does the paper differ from or confirm previous evidence?

Reviewer 2

The manuscript still lacks detailed information on the extent and nature of stakeholder involvement in the co-creation process with hospital staff. Providing more specifics about stakeholder engagement, the feedback process, and how their input influenced the development of the decision support tool (DST) would enhance the study's validity and relevance. Furthermore, the manuscript would benefit from a more thorough discussion of its limitations, including challenges related to data collection and potential biases in stakeholder engagement. Addressing these limitations would provide a more balanced perspective on the study's contributions and scope.

==============================

Please submit your revised manuscript by Jan 05 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Moses Mukuru, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear Authors,

thank you very much for the possibility to read again your paper after the first round of revision.

I really appreciate the efforts that you adopted to improve your work.

I have some comments to finalize the work:

- the paragraph "ICM in the UK: Policy and Practice" is well conceived, but I think that this paragraph is not so connected with the other introductive sections, and this should be a problem for the paper's readiness. Why do you not think to introduce the concepts and the topics of this paragraph in the first part of the Introduction and then maintain the section of the Literature review?

- the Table 1 allows to better clarify the role of the proposed questions on the light of the background provided but anyway, I think that also one or two more precise research question(s) for the paper, connected with the objective defined by the authors, should be proposed to help the reader understanding all the paper

- considering that the authors stated in the methodological section that semi-structured interviews and focus group were conducted, I think that some details regarding the questions posed or the information/areas investigated should help.

- another important point that I think is missing also in this updated version of the paper is related to the comparison of the presented study with other already published evidence. How the paper differs from or confirm previous evidence?

Good luck for the publication!

Reviewer #2: Thank you for the opportunity to re-review this manuscript. I enjoyed reading it.

While the authors have addressed most of the previously raised comments, the manuscript still lacks detailed information on the extent and nature of stakeholder involvement in the co-creation process with hospital staff. Providing more specifics about stakeholder engagement, the feedback process, and how their input influenced the development of the decision support tool (DST) would enhance the study's validity and relevance. Furthermore, the manuscript would benefit from a more thorough discussion of its limitations, including challenges related to data collection and potential biases in stakeholder engagement. Addressing these limitations would provide a more balanced perspective on the study's contributions and scope.

Reviewer #3: .

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

PONE-D-24-19911R2Research-informed decision-making for empowering integrated care system development: Co-creating innovative solutions to facilitate enhanced service provisionPLOS ONE

Dear Dr. Demir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 23 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Dr. Mohammed Misbah Ul Haq, Pharm-D

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: No

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Thank you for the revision. While the manuscript addresses an important topic, key concerns remain unresolved. The study heavily relies on literature review without sufficiently synthesizing key theoretical contributions, and a clear theoretical framework is lacking. Additionally, the methodology section lacks critical details, including the number of interviews and focus groups conducted, participant selection criteria, and the thematic analysis process for qualitative data. The absence of clarity on the sampling method, number of participants, and consideration of data saturation affects the study’s transparency and reproducibility.

The ethics statement mentions that "no ethics approval was required as the study did not involve human subjects," yet interviews and focus groups were conducted. Given these limitations, I regret to recommend rejection at this stage. However, I encourage the authors to refine the manuscript, enhance methodological rigor, and seek publication in a more suitable venue.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Research-informed decision-making for empowering integrated care system development: Co-creating innovative solutions to facilitate enhanced service provision

PONE-D-24-19911R3

Dear Dr. Eren Demir,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Dr. Mohammed Misbah Ul Haq, Pharm-D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: