Jonathan R Clark, Maike Tietschert, Michaela Kerrissey, Mark Friedberg, Sara J Singer
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引用次数: 0
Abstract
Background: Substantial variation exists in how well health care is integrated, even across similarly structured organizations, yet research about what physician organizations (POs) do that enables or inhibits integrated care is limited.
Purpose: The aim of this study was to explore the dynamics that enable POs to integrate care.
Methodology/approach: We ranked a stratified sample of POs according to patient perceptions of integrated care, as measured in a survey. We interviewed professionals, patients, and family members in 10 higher and 3 lower ranked POs about the process of caring for patients with complex conditions. We derived integration-related themes from the interview data and quantified their prevalence. Using a quasi-statistical approach, we explored relationships among themes and their associations with patient perceptions of integrated care.
Results: From 6,104 coded references, we derived a set of themes representing integration perspectives, integration engagement mechanisms, and integration failures. POs experienced frequent integration failures. Higher ranked POs experienced these failures less often because of a combination of functional, interpersonal, and stakeholder engagement mechanisms, which appear to complement one another. Integration perspectives, including both people-oriented and systems-oriented mindsets, appear to play a role in generating these integration dynamics.
Conclusion: Delivering integrated care depends on a PO's ability to limit integration failures, keeping provider attention focused on patients. Building on the attention-based view, we present a framework suggesting that this ability is a function of both integration perspectives and integration engagement mechanisms.
Practice implications: POs interested in delivering more integrated care should employ a variety of complementary integration engagement mechanisms and facilitate these efforts by nurturing both people-oriented and system-oriented mindsets among PO decision-makers.
期刊介绍：
Health Care Management Review (HCMR) disseminates state-of-the-art knowledge about management, leadership, and administration of health care systems, organizations, and agencies. Multidisciplinary and international in scope, articles present completed research relevant to health care management, leadership, and administration, as well report on rigorous evaluations of health care management innovations, or provide a synthesis of prior research that results in evidence-based health care management practice recommendations. Articles are theory-driven and translate findings into implications and recommendations for health care administrators, researchers, and faculty.
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