迈向整合卫生服务的价值观框架：一项国际德尔菲研究。

BACKGROUND: In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations. Therefore, this article focuses on these underlying normative aspects of integrated health services. This study investigates the values that underpin integrated health services delivery as a concept, by examining the extent to which an initial literature based set of underlying values underpins integrated care and the relevance of these values on the different levels of integration. METHODS: An international Delphi study with 33 experts from 13 different countries was carried out to examine the initial set of underlying values of integrated health services. In addition, the relevance of the values was assessed on the different levels of integration: personal level, professional level, management level and system level. RESULTS: The study resulted in a refined set of 18 values of integrated health services developed in three Delphi study rounds. In addition, the results provided insight into the relevance of these values on the personal level (e.g. 'trustful'), professional level (e.g. 'collaborative'), management level (e.g. 'efficient') and system level (e.g. 'comprehensive') of integration. Some of the values score consistent across the different levels of integration while other values score inconsistent across these levels. CONCLUSIONS: The Delphi study resulted in an international normative basis for integrated health services delivery as a concept. The values can be used as ingredients for a values framework and provide a better understanding of the normative aspects of integrated health services delivery. Future research could focus on associated behaviors in practice, the relationship between normative integration and governance, and differences between the value priorities of stakeholder groups.

背景：为了为数以百万计的有多种复杂健康和社会护理需求的人提供以人为本的健康服务，必须从分散的服务模式向整合的服务模式转变。为了组织整合健康服务的治理，有必要更好地理解推动个人和组织之间合作、决策和行为的潜在因素。因此，本文侧重于整合健康服务的这些潜在规范性方面。本研究通过检查初始基于文献的一组潜在价值观在多大程度上为整合护理提供基础，以及这些价值观在不同整合水平上的相关性，来研究作为一个概念的整合健康服务提供所依据的价值观。

方法：对来自 13 个不同国家的 33 名专家进行了一项国际德尔菲研究，以检验整合健康服务的初始潜在价值观。此外，还评估了这些价值观在不同整合层面的相关性：个人层面、专业层面、管理层面和系统层面。

结果：研究得出了一套经过三轮德尔菲研究精炼的 18 项整合健康服务价值观。此外，研究结果还深入了解了这些价值观在个人层面（例如，“信任”）、专业层面（例如，“协作”）、管理层面（例如，“高效”）和系统层面（例如，“全面”）的相关性。一些价值观在不同的整合层面上的得分一致，而其他价值观在这些层面上的得分不一致。

结论：德尔菲研究为整合健康服务作为一个概念的提供奠定了国际规范性基础。这些价值观可以作为价值观框架的组成部分，有助于更好地理解整合健康服务提供的规范性方面。未来的研究可以集中在实践中的相关行为、规范性整合与治理之间的关系以及利益相关者群体的价值优先事项之间的差异。