出版社：Utrecht University, Maastricht University, Groningen University
摘要：Objective : To show the progress in Integrated Care in the Basque Country through the evaluation of compliance of “Dimension 3: Integrated care” in Contract Program. Methods : The Health Regulation Act of the Basque Country establishes the Contract Program (CP) as a regulation tool between the commissioner (Ministry of Health) and health providers (Osakidetza/Basque Health Service, etc.). The CP set financing and quality requirements. Therefore, in 2014 it was decided to use CP as an additional tool to drive real changes in health care organizations, in order to advance towards Integrated Care. To do this, a new orientation was necessary, both for the quality requirements and the way to evaluate their degree of compliance. So, based on the Conceptual Framework developed by Kelley and Hurst with some modifications, we carry out an assessment model of the quality requirements in contracting. The model should meet the requirements of being: Integrated, based on international standards, that allow comparisons and, by means of weightings, give more importance to elements considered "critical” (for example: Integrated care); sensitive and viable by using the existing or easily constructible indicators. The result was a model with two axes of contracting and nine dimensions: The first axis (focused on the design and planning of services) contains 3 dimensions: D1: Resources; D2: Services and D3: Integrated care. The second one deals with the performance of the organizations and contains 6 dimensions: D4: clinical safety, D5: effectiveness, D6: Equity, D7: Centrality in the patients, D8: Accessibility to health services and D9: Efficiency. D3 (Integrated Care) contains 4 indicators (5 indicators in 2017): Ambulatory care sensitive conditions (ACSCs) admissions Rate: Integration degree (Collaboration between clinicians from different care levels measured with the D'Amour Questionnaire) Coordination degree for geriatric care in elderly homes Coordination degree in polypathological patients management Strengthening primary health care (included in 2017) Results : Compliance of indicators and D3. Ambulatory Care Sensitive Conditions (ACSCs) 2014 30,0 2015 30,6 2016 69,2 2017 87,4 Integration degree 2014 53,3 2015 65,4 2016 81,6 2017 93,6 *Only Long term care Coordination degree for geriatric care in elderly homes 2014 27,9 2015 55,4 2016 59,2 2017 74,3 Coordination degree in polypathological patients management 2014 53,7 2015 53,1 2016 73,6 2017 82,2 Strengthening primary health care 2017 71,8 Overall compliance 2014 54,0 2015 63,8 2016 73,3 2017 83,3 Conclusions : The positive evolution reflects the effective implementation of actions aimed at real integrated care (functional integrated care), beyond structural integration. These actions include implementation of only one information system, Integrated care processes deployment, New professional roles, New alliances (Social care participation), Professional participation, Multidisciplinary Committees, etc.
