Linkage, coordination and integration: evidence from rural palliative care.
Linkage, coordination and integration: evidence from rural palliative care.
复制标题
联系、协调和整合：来自农村姑息治疗的证据。
DOI：
10.1111/j.1440-1584.2009.01089.x
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Alan G Owen
中科院分区：
文献类型：
--
作者：
Malcolm R Masso;Alan G Owen
目标
回顾三个农村姑息治疗项目的评估结果。
设计
作者对每次评估的原始材料进行审查。 Leutz 的工作提供了审查的概念框架，包括他对联系、协调和充分整合之间的区分。
设置
澳大利亚农村地区基于社区的姑息治疗。
干预措施
澳大利亚所有六个州的十五个项目重点关注全科医生和其他社区卫生服务提供者之间的整合。
结果
这些项目旨在改善提供商之间的网络和协作；改善患者护理的协调和整合；减少重复服务；并实现姑息治疗的多学科协作方法。最常见的干预措施是建立正式的治理结构、提供教育计划、案例会议、传播信息、制定正式安排、制定协议和使用通用临床评估工具。 “整合”和“协调”这两个术语被频繁使用，但没有明确的定义。协调需要专门指定专人进行协调，通常是护士。改善联系和协调的正式安排很难维持。实现全面整合的主要机制是共同临床信息系统的开发。
结论
Leutz 提出的“法律”以及联系、协调和全面整合的概念提供了一个有用的框架，以了解整合全科医生和其他医疗服务提供者的障碍。明确需要什么级别的集成非常重要。改善联系可能就足够了（而且是现实的），而不是努力实现全面整合。
OBJECTIVE
Review the findings from the evaluations of three rural palliative care programs.
DESIGN
Review by the authors of the original material from each evaluation. The conceptual framework for the review was provided by the work of Leutz, including his distinction between linkage, coordination and full integration.
SETTING
Community-based palliative care in rural Australia.
INTERVENTIONS
Fifteen projects across all six states of Australia that focused on integration between general practitioners and other community-based health providers.
RESULTS
The projects set out to improve networking and collaboration between providers; improve coordination and integration of care for patients; reduce duplication of services; and achieve a multidisciplinary, collaborative approach to palliative care. The most common interventions were establishment of formal governance structures, provision of education programs, case conferencing, dissemination of information, development of formal arrangements, development of protocols and use of common clinical assessment tools. The terms 'integration' and 'coordination' were used frequently but without clear definitions. Coordination required someone specifically designated to do the coordinating, usually a nurse. Formal arrangements to improve linkage and coordination were difficult to maintain. The main mechanism to achieve full integration was the development of common clinical information systems.
CONCLUSIONS
The 'laws' proposed by Leutz and the concepts of linkage, coordination and full integration provide a useful framework to understand the barriers to integrating GPs and other health providers. It is important to be clear on what level of integration is required. Improving links might be sufficient (and realistic), rather than striving for full integration.