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Given the centrality of legislatures in our representative system of government, it is a remarkable fact that there is today no general, systematic history of state legislative development in America. There are numerous studies of particular laws or individual legislators, but the process by which this important institution evolved historically and its role in the political system remain largely unexplored. The internal development of state legislatures in the century or so after the Revolution, as Ronald Formisano (1974: 480) has observed, is "generally almostterra incognitato historians" (see also Zemsky, 1973; Bogue, 1974; Campbell, 1976). The men who served as legislators in this period are equally obscure. Historians have also assumed, without investigating the proposition, that policy making was the primary function of legislatures and that citizens were linked to that policy-making process through representatives. Studies of past legislative behavior have focused principally on the role of political parties and interest groups in the conversion of constituent demands into public policy.

The American states experienced an extraordinary political transformation in the middle decades of the nineteenth century. For more than a generation state governments had stimulated economic development by subsidizing agriculture and industry, investing in private enterprise, constructing internal improvements at public expense or lending the public credit for such purposes, and granting special privileges to private companies. By the mid-1840's, however, the states had begun to assume a more passive role. Accompanying this withdrawal from economic activity and associated with it was a general restructuring of state political systems. New state constitutions, the most visible evidence of such change, lowered suffrage requirements, stripped legislatures of the appointing power, and extended the elective process to more state offices. They also curtailed legislative authority in economic policy areas by prohibiting certain types of activity; requiring general incorporation laws in place of special charters; establishing detailed procedures for managing state debts and public works; and, in some instances, mandating specific policy actions.

Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important.