Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system.
Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system.
复制标题
DOI：
10.1186/1472-6963-10-91
复制
发表时间：
2010-04-08
影响因子：
2.8
通讯作者：
Hsu J
中科院分区：
文献类型：
--
作者：
Strandberg-Larsen M;Schiøtz ML;Silver JD;Frølich A;Andersen JS;Graetz I;Reed M;Bellows J;Krasnik A;Rundall T;Hsu J
跨临床医生和环境的医疗护理整合可以提高患者的护理质量。迄今为止，关于实际融入程度的数据有限。我们的目的是比较初级保健临床医生的临床整合和三个子方面的两个医疗保健系统：凯撒永久，北方加州（KPNC）和丹麦医疗保健系统（DHS）的看法。此外，我们研究了特定的组织因素和每个系统内的临床整合之间的关联。比较问卷发送给随机抽样的初级保健临床医生在KPNC（n = 1103）和全科医生在DHS（n = 700）。使用多元逻辑回归模型分析数据。KPNC中更多的临床医生认为是临床综合环境的一部分，而DHS中的全科医生则认为是（OR = 3.06，95%CI：2.28，4.12）。此外，更多的KPNC临床医生报告了信息传递的及时性（OR = 2.25，95% CI：1.62，3.13），角色和责任的一致性（OR = 1.79，95% CI：1.30，2.47），并建立了协调机制，以确保有效的协调（OR = 6.80，95% CI：4.60，10.06）。亚国家分析中考虑的组织因素均不能解释临床整合中的大部分变异。更多的初级保健临床医生在KPNC报告临床整合比全科医生在DHS。临床整合的重点措施需要发展临床整合领域，并创建科学基础，以指导管理人员寻找循证方法。
Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.
登录
查看更多内容
影响因子：
2.5
作者：
Burns, LR;Walston, SL;Hilberman, D
通讯作者：
Hilberman, D
影响因子：
7.2
作者：
Asch, DA;Jedrziewski, MK;Christakis, NA
通讯作者：
Christakis, NA
影响因子：
--
作者：
CARTWRIGHT, A
通讯作者：
CARTWRIGHT, A
影响因子：
3.3
作者：
Collins, C;Green, A;Hunter, D
通讯作者：
Hunter, D
影响因子：
--
作者：
Crosson, FJ
通讯作者：
Crosson, FJ