The Medical Management Centre, Karolinska Institute, Sweden.
Health Policy. 2010 Oct;97(2-3):113-21. doi: 10.1016/j.healthpol.2010.05.012. Epub 2010 Jun 16.
Research and citizens have noted failures in coordinating health and social services and professionals, and the need to address this issue to realize benefits from increasing specialisation. Different methods have been proposed and one has been structural integration of separate services within one organisation. This paper reports an empirical longitudinal study of the development of an integrated health and social care organisation in Sweden combining service provision, purchasing and political governance for a defined population. The study found a combination of influences contributed to the development of this new organisation. The initial structural macro-integration facilitated, but did not of itself result in better clinical care coordination. Other actions were needed to modify the specialised systems and cultures which the organisation inherited. The study design was not able to establish with any degree of certainty whether better patient and cost outcomes resulted, but it did find structural and process changes which make improved outcomes likely. The study concludes that coordinated actions at different levels and of different types were needed to achieve care coordination for patients and that a phased approach was necessary where management capacity and outside expertise are limited.
研究和公民注意到协调卫生和社会服务以及专业人员方面的失败，需要解决这个问题，以从日益专业化中实现效益。已经提出了不同的方法，其中之一是在一个组织内整合单独的服务。本文报告了对瑞典一个整合卫生和社会保健组织的发展的一项实证纵向研究，该组织结合了特定人群的服务提供、采购和政治治理。研究发现，多种因素的综合影响促成了这个新组织的发展。最初的结构宏观整合提供了便利，但本身并没有导致更好的临床护理协调。需要采取其他行动来改变组织继承的专业化系统和文化。研究设计无法确定是否会带来更好的患者和成本结果，但确实发现了结构和流程的变化，这使得改善结果变得更加可能。该研究得出结论，需要在不同层面和不同类型上采取协调行动，为患者实现护理协调，并且在管理能力和外部专业知识有限的情况下，需要采取分阶段的方法。
