Saunders Carla, Carter David J
Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007(PO Box 222), Australia. Email.
Aust Health Rev. 2017 May;41(2):154-161. doi: 10.1071/AH15191.
Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.
目标 提供真正的综合医疗服务是新南威尔士州（NSW）政府《2021年国家卫生计划》的三大战略方向之一。本研究调查了新南威尔士州每个地方卫生区（LHD）当前的关键卫生服务计划，以评估当前规划的卫生系统整合战略的程度和性质。方法 进行了一项范围界定审查，以确定成功进行卫生系统整合的共同关键原则和做法，从而开发一种评估工具，对地方卫生区的战略卫生服务计划进行内容评估。结果 各地方卫生区计划的卫生系统整合战略最常侧重于改善州和联邦资助系统、提供者及机构在整个护理连续过程中对复杂高危患者的协调、医疗服务可及性及护理提供。开展整合活动最常见的理由是减少可避免的住院、避免不适当的急诊科就诊以及改善患者护理。结论 尽管卫生系统整合很重要，且发现新南威尔士州所有地方卫生区在其当前的战略卫生计划中都对整合做出了一定承诺，但该分析表明，新南威尔士州的卫生系统整合尚处于相对早期的发展阶段。关于该主题已知什么？ 已发现管理复杂慢性病的有效方法涉及卫生系统整合，这需要社区和医院环境中的医疗服务提供者之间进行良好的沟通与联系。基于当前卫生系统整合知识进行规划以确保有效利用稀缺资源是所有卫生系统的责任。本文补充了什么？ 卫生系统整合的适当规划和实施正日益成为有效卫生系统的重要期望和要求。本研究是同类研究中首个评估新南威尔士州公共卫生系统卫生系统整合计划活动的研究。新南威尔士州卫生区在卫生系统整合中发挥核心作用；每个卫生服务计划概述了未来几年每个地区所有州资助服务的发展和提供的战略方向，相当于数亿澳元的卫生部门资金。纳入有效的卫生系统整合战略使地方卫生区能够为优质患者结局和长期财务可持续性奠定基础，尽管预计卫生服务需求会增加。对实践有何影响？ 建立有效的卫生系统整合的稳健持续机制现在是卫生规划的必要组成部分。本研究确定了几个关键领域和战略，范围广泛且表明了卫生系统整合的努力方向，这可能支持地方卫生区和其他组织进行系统规划和实施。
