Bartel S, Bethge M, Streibelt M, Thren K, Lassahn C
Charité Campus Mitte, Abteilung für Versorgungs-systemforschung und Grundla-gen der Qualitätssicherung in der Rehabilitation Luisenstrasse, 10098, Berlin.
Rehabilitation (Stuttg). 2010 Jun;49(3):138-46. doi: 10.1055/s-0030-1249669. Epub 2010 Jun 8.
In Germany, introduction of the law on Integrated Health Care (IC) (section sign 140a-d SGB V) opened up the possibility of cross-sectoral health care settings and new forms of remuneration, and improved the conditions for a closer cooperation between health care providers. However, cross-institutional and interdisciplinary work contexts demand new organizational structures in order to assure the coordination of different competences, resources and interests. This study aims at identifying factors of successful integrated care settings for total hip and knee arthroplasty. Using the example of an integrated care setting between an orthopaedic hospital and a rehabilitation clinic it will be examined which factors lead to successful implementation of the services and measures designed.
A qualitative research design was developed comprising different methods of data assessment (participant observation, guided expert interviews, document analyses) enabling a comprehensive exploration. Overall, data were derived from six consultations with patients, two integrated care information sessions and various documents (17 patient files, information material, patient lists, etc.).
First of all, the different phases of development and implementation of integrated care settings were described. In this context, clearly defined aims, structures and appropriate measures seem to be crucial for an ideal long-term cooperation. Furthermore, the staff perspective on the effects of the IC programme on their daily routines proved an essential basis for process reconstruction. The staff members pointed out four main aspects regarding IC settings, i. e., improved image, increased knowledge, intensity of relationship, and less and more work effort. Against this background, factors of successful IC settings could be generated such as the need for central coordination, a regular staff information systems as well as accompanying process monitoring.
Several key factors of successful integrated care settings in arthroplasty could be generated which provide important clues for shaping future interdisciplinary and cross-sectoral cooperation settings in health care services in general.
在德国，《综合医疗保健法》（第140a - d条，《社会法典》第五编）的出台开启了跨部门医疗保健模式及新薪酬形式的可能性，并改善了医疗服务提供者之间加强合作的条件。然而，跨机构和跨学科的工作环境需要新的组织结构，以确保不同能力、资源和利益之间的协调。本研究旨在确定全髋关节和膝关节置换术综合护理成功实施的因素。以一家骨科医院和一家康复诊所之间的综合护理模式为例，研究哪些因素有助于成功实施所设计的服务和措施。
采用定性研究设计，包括不同的数据评估方法（参与观察、专家访谈、文件分析），以进行全面探索。总体而言，数据来自与患者的六次会诊、两次综合护理信息会议以及各种文件（17份患者档案、宣传材料、患者名单等）。
首先，描述了综合护理模式发展和实施的不同阶段。在此背景下，明确的目标、结构和适当的措施似乎是理想的长期合作的关键。此外，工作人员对综合护理计划对其日常工作影响的看法被证明是流程重建的重要基础。工作人员指出了综合护理模式的四个主要方面，即形象改善、知识增加、关系强度以及工作量的增减。在此背景下，可以得出综合护理成功实施的因素，如中央协调的必要性、定期的员工信息系统以及伴随的流程监控。
可以得出关节置换术中综合护理成功实施的几个关键因素，这些因素为塑造未来医疗保健服务中跨学科和跨部门合作模式提供了重要线索。
