Leutz W N
Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, MA 02254, USA.
Milbank Q. 1999;77(1):77-110, iv-v. doi: 10.1111/1468-0009.00125.
Because persons with disabilities (PWDs) use health and social services extensively, both the United States and the United Kingdom have begun to integrate care across systems. Initiatives in these two countries are examined within the context of the reality that personal needs and use of systems differ by age and by type and severity of disability. The lessons derived from this scrutiny are presented in the form of five "laws" of integration. These laws identify three levels of integration, point to alternative roles for physicians, outline resource requirements, highlight friction from differing medical and social paradigms, and urge policy makers and administrators to consider carefully who would be most appropriately selected to design, oversee, and administer integration initiatives. Both users and caregivers must be involved in planning to ensure that all three levels of integration are attended to and that the borders between medical and other systems are clarified.
由于残疾人广泛使用健康和社会服务，美国和英国都已开始整合跨系统护理。鉴于个人需求以及系统使用情况因年龄、残疾类型和严重程度而异这一现实背景，对这两个国家的举措进行了审视。从这种审视中得出的经验教训以整合的五条“法则”形式呈现。这些法则确定了三个整合层次，指出了医生的不同角色，概述了资源需求，突出了不同医学和社会范式之间的摩擦，并敦促政策制定者和管理人员仔细考虑谁最适合被选来设计、监督和管理整合举措。用户和护理人员都必须参与规划，以确保三个整合层次都得到关注，并且明确医疗系统和其他系统之间的界限。
