出版社：Utrecht University, Maastricht University, Groningen University
摘要：Several studies have contributed to the development of theoretical frameworks for integrated care implementation. The scholarly articles and technical reports published on the topic identify factors or structures of elements fostering care integration: most often they target people suffering from chronic and/or long term conditions. In addition, the majority of these studies focus on a specific context of implementation, hence they do not appreciate the influential role that contextual factors in care integration can play in determining outcomes (González et al., 2018). In particular, most of the literature in the field deals with initiatives implemented in European countries, Australia or North America. While relatively few studies have been conducting specifically for Latin American countries, where high levels of health care fragmentation are evident. A pioneering work concerning integrated care in Latin American’s networks was done by Vázquez et al. (2009). Based on a review of the literature published in the period 1983-2007, the authors presented a conceptual framework for the analysis of the different types of integrated health care networks operating in the Latin American context. More recently, Montenegro et al. (2011) published a contribution where they discussed the lessons learned from the PAHO’s integrated health service delivery networks (IHSDNs) initiative aimed to address the challenges of care integration and continuity of care in Latin American countries. Results suggest that the context matter and, therefore, different contexts require different strategies to achieve success. Based on the Project INTEGRATE’s conceptual framework (www.projectintegrate.eu.com/integrated-care/resource/the-project-integrate-framework) and on a preliminary pilot study conducted in the Summer School at the University of Lugano (July 2018) – involving health professionals/managers from Argentina, Chile and Brazil – we intend to test which elements of the Project INTEGRATE framework are fully suitable to foster implementation of integrated care in the Latin America context, which ones needs to be adapted, and which ones should be further included. Our objective is to propose a framework tailored for Latin American, capturing contextual differences that may be determinant for implementing care integration in the countries of this specific geographic area (for instance, due to the peculiarities of the health systems). The research strategy will involve local experts, decision makers and managers from different health organizations experiencing or seeking care integration. Preliminary results arising from the pilot study suggest that the Latin American context has some particularities that must be taken into account in order to develop a suitable framework to analyze or implement integrated care in such setting. Results may contribute to tackle fragmentation of care and to foster care integration in Latin American countries.
关键词：framework ; integrated care ; chronic conditions ; benchmarking
