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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar 2 organizaciones sanitarias integradas &#40;OSI&#41; en Catalu&#241;a e identificar las &#225;reas de desarrollo futuro que mejoren su eficacia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Investigaci&#243;n cualitativa&#44; exploratoria y descriptiva&#44; basada en un estudio de casos&#44; mediante an&#225;lisis de documentos y entrevista individual semiestructurada&#46; Se seleccion&#243; una muestra te&#243;rica de casos y&#44; para cada caso&#44; de documentos e informantes&#46; Los casos de estudio fueron&#58; el Consorci Sanitari del Maresme &#40;CSdM&#41; y el Consorci Sanitari de Terrassa&#47;Fundaci&#243; Hospital Sant Ll&#224;tzer &#40;CSdT&#47;FHSLL&#41;&#46; Se analizaron 127 documentos y se entrevistaron 29 informantes&#58; directivos de las OSI &#40;n &#61; 10&#41;&#44; t&#233;cnicos de apoyo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; directivos de las unidades operativas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; y profesionales asistenciales &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46; Se realiz&#243; un an&#225;lisis de contenido&#44; con generaci&#243;n mixta de categor&#237;as y segmentaci&#243;n por casos y temas&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El CSdM y el CSdT&#47;FHSLL son organizaciones sanitarias con integraci&#243;n vertical hacia atr&#225;s&#44; producci&#243;n total de servicios&#44; con propiedad real &#40;CSdM&#41; y virtual &#40;CSdT&#47;FHSLL&#41;&#46; Reciben la financiaci&#243;n por nivel asistencial&#46; El &#243;rgano de gobierno es centralizado en CSdM y descentralizado en CSdT&#47;FHSLL&#46; En ambas&#44; los objetivos globales se orientan a la mejora de la coordinaci&#243;n y la eficiencia&#44; pero sin alinearse con los de las unidades operativas&#46; Su estructura es funcional&#44; con integraci&#243;n de las funciones de apoyo&#44; y utilizan mecanismos de coordinaci&#243;n entre niveles asistenciales basados en la normalizaci&#243;n de los procesos de trabajo&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se identifican los elementos facilitadores y tambi&#233;n las barreras a la coordinaci&#243;n&#44; que requieren cambios tanto del entorno &#40;sistema de asignaci&#243;n&#41; como internos &#40;papel del gobierno&#44; estructura organizativa y tipos de mecanismos de coordinaci&#243;n entre niveles&#41;&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze 2 integrated delivery systems &#40;IDS&#41; in Catalonia and identify areas for future development to improve their effectiveness&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">An exploratory&#44; descriptive&#44; qualitative study was carried out based on case studies by means of document analysis and semi-structured individual interviews&#46; A criterion sample of cases and&#44; for each case&#44; of documents and informants was selected&#46; Study cases consisted of the Consorci Sanitari del Maresme &#40;CSdM&#41; and the Consorci Sanitari de Terrassa&#47;Fundaci&#243; Hospital Sant Ll&#224;tzer &#40;FHSLL&#41;&#46; A total of 127 documents were analyzed and 29 informants were interviewed&#58; IDS managers &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&#44; technical staff &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; operational unit managers &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; and health professionals &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46; Content analysis was conducted&#44; with mixed generation of categories and segmentation by cases and subjects&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">CSdM and CSdT&#47;FHSLL are health care organizations with backward vertical integration&#44; total services production&#44; and real &#40;CSdM&#41; and virtual &#40;CSdT&#47;FHSLL&#41; ownership&#46; Funds are allocated by care level&#46; The governing body is centralized in CSdM and decentralized in CSdT&#47;FHSLL&#46; In both organizations&#44; the global objectives are oriented toward improving coordination and efficiency but are not in line with those of the operational units&#46; Both organizations present a functional structure with integration of support functions and utilize mechanisms for collaboration between care levels based on work processes standardization&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Both IDS present facilitators and barriers to health care coordination&#46; To improve coordination&#44; changes in external elements &#40;payment mechanism&#41; and in internal elements &#40;governing body role&#44; organizational structure and coordination mechanisms&#41; are required&#46;</p>"
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Originales
Barreras y facilitadores de la coordinación asistencial en dos organizaciones sanitarias integradas en Cataluña
Barriers and facilitators to health care coordination in two integrated health care organizations in Catalonia [Spain]
Ingrid Vargas Lorenzo
Autor para correspondencia
ivargas@chc.es

Correspondencia: Dra. Ingrid Vargas Lorenzo. Servei d’Estudis i Prospectives en polítiques de salut del Consorci Hospitalari de Catalunya. Avda. Tibidabo, 21, 08022 Barcelona. España.
, M. Luisa Vázquez Navarrete
Servei d’estudis i prospectives en polítiques de salut, Consorci Hospitalari de Catalunya, Barcelona, España
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar 2 organizaciones sanitarias integradas &#40;OSI&#41; en Catalu&#241;a e identificar las &#225;reas de desarrollo futuro que mejoren su eficacia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Investigaci&#243;n cualitativa&#44; exploratoria y descriptiva&#44; basada en un estudio de casos&#44; mediante an&#225;lisis de documentos y entrevista individual semiestructurada&#46; Se seleccion&#243; una muestra te&#243;rica de casos y&#44; para cada caso&#44; de documentos e informantes&#46; Los casos de estudio fueron&#58; el Consorci Sanitari del Maresme &#40;CSdM&#41; y el Consorci Sanitari de Terrassa&#47;Fundaci&#243; Hospital Sant Ll&#224;tzer &#40;CSdT&#47;FHSLL&#41;&#46; Se analizaron 127 documentos y se entrevistaron 29 informantes&#58; directivos de las OSI &#40;n &#61; 10&#41;&#44; t&#233;cnicos de apoyo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; directivos de las unidades operativas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; y profesionales asistenciales &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46; Se realiz&#243; un an&#225;lisis de contenido&#44; con generaci&#243;n mixta de categor&#237;as y segmentaci&#243;n por casos y temas&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El CSdM y el CSdT&#47;FHSLL son organizaciones sanitarias con integraci&#243;n vertical hacia atr&#225;s&#44; producci&#243;n total de servicios&#44; con propiedad real &#40;CSdM&#41; y virtual &#40;CSdT&#47;FHSLL&#41;&#46; Reciben la financiaci&#243;n por nivel asistencial&#46; El &#243;rgano de gobierno es centralizado en CSdM y descentralizado en CSdT&#47;FHSLL&#46; En ambas&#44; los objetivos globales se orientan a la mejora de la coordinaci&#243;n y la eficiencia&#44; pero sin alinearse con los de las unidades operativas&#46; Su estructura es funcional&#44; con integraci&#243;n de las funciones de apoyo&#44; y utilizan mecanismos de coordinaci&#243;n entre niveles asistenciales basados en la normalizaci&#243;n de los procesos de trabajo&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se identifican los elementos facilitadores y tambi&#233;n las barreras a la coordinaci&#243;n&#44; que requieren cambios tanto del entorno &#40;sistema de asignaci&#243;n&#41; como internos &#40;papel del gobierno&#44; estructura organizativa y tipos de mecanismos de coordinaci&#243;n entre niveles&#41;&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze 2 integrated delivery systems &#40;IDS&#41; in Catalonia and identify areas for future development to improve their effectiveness&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">An exploratory&#44; descriptive&#44; qualitative study was carried out based on case studies by means of document analysis and semi-structured individual interviews&#46; A criterion sample of cases and&#44; for each case&#44; of documents and informants was selected&#46; Study cases consisted of the Consorci Sanitari del Maresme &#40;CSdM&#41; and the Consorci Sanitari de Terrassa&#47;Fundaci&#243; Hospital Sant Ll&#224;tzer &#40;FHSLL&#41;&#46; A total of 127 documents were analyzed and 29 informants were interviewed&#58; IDS managers &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&#44; technical staff &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; operational unit managers &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; and health professionals &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46; Content analysis was conducted&#44; with mixed generation of categories and segmentation by cases and subjects&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">CSdM and CSdT&#47;FHSLL are health care organizations with backward vertical integration&#44; total services production&#44; and real &#40;CSdM&#41; and virtual &#40;CSdT&#47;FHSLL&#41; ownership&#46; Funds are allocated by care level&#46; The governing body is centralized in CSdM and decentralized in CSdT&#47;FHSLL&#46; In both organizations&#44; the global objectives are oriented toward improving coordination and efficiency but are not in line with those of the operational units&#46; Both organizations present a functional structure with integration of support functions and utilize mechanisms for collaboration between care levels based on work processes standardization&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Both IDS present facilitators and barriers to health care coordination&#46; To improve coordination&#44; changes in external elements &#40;payment mechanism&#41; and in internal elements &#40;governing body role&#44; organizational structure and coordination mechanisms&#41; are required&#46;</p>"
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Información del artículo
ISSN: 02139111
Idioma original: Español
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