Angus Lisa, Valentijn Pim P
Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
Department of Patient and Care, Maastricht University Medical Center, Plein Debyelaan 25, NL-6202 AZ Maastricht, Netherlands.
Aust J Prim Health. 2018 Mar;24(1):59-65. doi: 10.1071/PY17024.
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.
许多国家和卫生系统都在推行整合式照护，以此作为实现更好成效的一种方式。然而，目前尚无标准方法可用于跨模式或跨环境比较整合方法，也无法评估不同举措中是否具备整合式照护的关键要素。本研究借助一种新工具，从微观、中观和宏观层面描述并比较整合策略，从而揭示澳大利亚整合式照护的实施情况。总共38个整合式照护项目经过有目的抽样，其114名工作人员完成了一项基于整合式照护彩虹模型的调查。10名关键信息提供者接受了跟进访谈。参与项目的机构报告称，在实施整合式照护时采用了多种策略，但实施情况的描述往往并不一致。最常被提及的是微观层面的策略，包括临床-专业服务协调和以人为本的照护。共同愿景常被视为联合工作的重要基础。然而，绩效反馈似乎未得到充分利用，需要宏观层面行动的策略，如数据链接或支付改革，也是如此。结果表明，目前整合式照护工作在微观层面策略上的侧重不均衡。为加快澳大利亚整合式照护的进展并维持其发展，可能有必要更多地关注宏观层面的策略。
