TY - JOUR
T1 - Community-based integrated care: myth or must?
AU - Plochg, T.
AU - Klazinga, N. S.
PY - 2002
Y1 - 2002
N2 - Issue. In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care. Addressing the issue. This fact can be shown by reducing the complexity of today's health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way. Demonstrating the proposed solution. Community-based integrated care is a promising approach to addressing this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands
AB - Issue. In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care. Addressing the issue. This fact can be shown by reducing the complexity of today's health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way. Demonstrating the proposed solution. Community-based integrated care is a promising approach to addressing this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands
U2 - https://doi.org/10.1093/oxfordjournals.intqhc.a002606
DO - https://doi.org/10.1093/oxfordjournals.intqhc.a002606
M3 - Article
C2 - 11954688
SN - 1353-4505
VL - 14
SP - 91
EP - 101
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 2
ER -