From micro to macro: assessing implementation of integrated care in Australia
From micro to macro: assessing implementation of integrated care in Australia
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DOI：
10.1071/py17024
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发表时间：
2018-01-01
影响因子：
1.3
通讯作者：
Valentijn, Pim P.
中科院分区：
文献类型：
--
作者：
Angus, Lisa;Valentijn, Pim P.
许多国家和卫生系统正在推行综合护理，作为取得更好成果的一种手段。然而，没有标准的方法存在比较模式或设置的整合方法，并评估是否在不同的举措中存在的综合护理的关键组成部分。这项研究揭示了综合护理是如何在澳大利亚实施，使用一种新的工具，在微观，中观和宏观层面上的整合战略进行评估和比较。总共有114名工作人员从一个有目的的样本38个综合护理项目完成了一项调查的基础上综合护理彩虹模式。10名关键线人接受了后续采访。参与的项目报告说，使用多种战略来实施综合护理，但实施的描述往往不一致。微观一级的战略，包括临床专业服务协调和以人为本的护理，是最常报告的。共同愿景往往被描述为联合工作的重要基础。然而，业绩反馈似乎没有得到充分利用，需要宏观一级行动的战略，如数据联系或支付改革也没有得到充分利用。结果表明，目前的综合护理工作是不均衡的加权对微观层面的战略。可能需要更加重视宏观一级的战略，以加快进展和维持澳大利亚的综合护理。
Many countries and health systems are pursuing integrated care as a means of achieving better outcomes. However, no standard approaches exist for comparing integration approaches across models or settings, and for evaluating whether the key components of integrated care are present in different initiatives. This study sheds light on how integrated care is being implemented in Australia, using a new tool to characterise and compare integration strategies at micro, meso and macro levels. In total, 114 staff from a purposive sample of 38 integrated care projects completed a survey based on the Rainbow Model of Integrated Care. Ten key informants gave follow-up interviews. Participating projects reported using multiple strategies to implement integrated care, but descriptions of implementation were often inconsistent. Micro-level strategies, including clinical professional service coordination and person-centred care, were most commonly reported. A common vision was often described as an essential foundation for joint work. However, performance feedback appeared under-utilised, as did strategies requiring macro-level action such as data linkages or payment reform. The results suggest that current integrated care efforts are unevenly weighted towards micro-level strategies. Increased attention to macro-level strategies may be warranted in order to accelerate progress and sustain integrated care in Australia.