Integrated care: a Danish perspective.

Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark.
BMJ (online) (Impact Factor: 16.38). 07/2012; 345:e4451. DOI: 10.1136/bmj.e4451
Source: PubMed
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    ABSTRACT: In 2007, a substantial reform changed the administrative boundaries of the Danish health care system and introduced health care agreements to be signed between municipal and regional authorities. To assess the health care agreements as a tool for coordinating health and social services, a survey was conducted before (2005-2006) and after the reform (2011). The study was designed on the basis of a modified version of Alter and Hage's framework for conceptualising coordination. Both surveys addressed all municipal level units (n = 271/98) and a random sample of general practitioners (n = 700/853). The health care agreements were considered more useful for coordinating care than the previous health plans. The power relationship between the regional and municipal authorities in drawing up the agreements was described as more equal. Familiarity with the agreements among general practitioners was higher, as was the perceived influence of the health care agreements on their work. Health care agreements with specific content and with regular follow-up and systematic mechanisms for organising feedback between collaborative partners exemplify a useful tool for the coordination of health and social services. There are substantial improvements with the new health agreements in terms of formalising a better coordination of the health care system.
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    ABSTRACT: Rehabilitation is a key element in most cancer care policies in recognition of the often unmet physical, psychological and social needs among the rising numbers of patients with cancer. A systematic assessment of patients' needs and available rehabilitation services constitute the foundation for timely, comprehensive and coordinated cancer rehabilitation. This study aims to provide insight into the current organisation and practice of cancer rehabilitation in Denmark with special emphasis placed on the assessment of patients' needs and availability of services across the cancer treatment trajectory. A cross-sectional design using a mixed methods approach will be used in order to analyse the readiness for cancer rehabilitation in different sectors and from differing perspectives. Substudy 1 consists of an electronic survey among the 98 Danish municipalities and focuses on the availability and use of cancer rehabilitation services for patients with all types of cancers. In substudy 2, a survey among the 19 surgical and 12 oncological departments involved in colorectal cancer treatment in Denmark is conducted in order to describe the current clinical practice regarding the assessment of rehabilitation needs and referral to services. Substudy 3 involves a retrospective clinical audit and semistructured interviews at four randomly selected surgical and oncological departments treating colorectal patients with cancer in order to elucidate current needs assessment practices. The study was approved by the Danish Data Protection Agency and will be conducted in accordance with the principles of the Helsinki Declaration Representatives from municipalities and clinical practice are engaged in the design and execution of the study in order to ensure the usefulness of survey instruments, reflexive interpretation of data and transfer of implications into practice. Published in international peer-reviewed scientific journals and presented at conferences, seminars and as short reports.
    BMJ Open 11/2013; 3(11):e003775. · 2.06 Impact Factor
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    ABSTRACT: Care for people with chronic conditions is an issue of increasing importance in industrialized countries. This article examines three recent efforts at care coordination that have been evaluated but not yet included in systematic reviews. The first is Germany's Gesundes Kinzigtal, a population-based approach that organizes care across all health service sectors and indications in a targeted region. The second is a program in the Netherlands that bundles payments for patients with certain chronic conditions. The third is England's integrated care pilots, which take a variety of approaches to care integration for a range of target populations. Results have been mixed. Some intermediate clinical outcomes, process indicators, and indicators of provider satisfaction improved; patient experience improved in some cases and was unchanged or worse in others. Across the English pilots, emergency hospital admissions increased compared to controls in a difference-in-difference analysis, but planned admissions declined. Using the same methods to study all three programs, we observed savings in Germany and England. However, the disease-oriented Dutch approach resulted in significantly increased costs. The Kinzigtal model, including its shared-savings incentive, may well deserve more attention both in Europe and in the United States because it combines addressing a large population and different conditions with clear but simple financial incentives for providers, the management company, and the insurer.
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