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"resumen" => "<span><p class="elsevierStyleSimplePara elsevierViewall">La mejora de la coordinación asistencial es una prioridad para muchos sistemas de salud y, especialmente, para la atención de problemas de salud crónicos en los que intervienen múltiples profesionales y servicios. La abundancia de estrategias y mecanismos de coordinación promovidos requiere una sistematización que ayude a utilizarlos de forma adecuada. El objetivo del artículo es analizar la coordinación asistencial y sus instrumentos, a partir de la teoría organizacional. Los mecanismos se pueden clasificar según el proceso básico utilizado para la coordinación de las actividades, programación o retroalimentación. La combinación óptima de mecanismos dependerá de 3 factores: grado de diferenciación de las actividades asistenciales, volumen y tipo de interdependencies y grado de incertidumbre. Históricamente, los servicios sanitarios han confiado la coordinación a la estandarización de las habilidades y, de manera más reciente, de los procesos mediante guías, mapas y planes. Su utilización resulta insuficiente para enfermedades crónicas en las que intervienen diversos profesionales con interdependencias recíprocas, variabilidad en la respuesta y un volumen de información procesada elevado. En este caso, son más efectivos los mecanismos basados en la retroalimentación, como grupos de trabajo, profesionales de enlace y sistemas de información vertical. La evaluación de la coordinación asistencial ha sido realizada hasta el momento de forma poco sistemática, mediante la utilización de indicadores de estructura, proceso y resultado. Las diversas estrategias e instrumentos se han aplicado, sobre todo, en los niveles sociosanitario y de salud mental; uno de los retos para la coordinación es extender y evaluar su uso a lo largo del continuo asistencial.</p></span>"
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"resumen" => "<span><p class="elsevierStyleSimplePara elsevierViewall">Improving healthcare coordination is a priority in many healthcare systems, particularly in chronic health problems in which a number of professionals and services intervene. There is an abundance of coordination strategies and mechanisms that should be systematized so that they can be used in the most appropriate context. The present article aims to analyse healthcare coordination and its instruments using the organizational theory.</p><p class="elsevierStyleSimplePara elsevierViewall">Coordination mechanisms can be classified according to two basic processes used to coordinate activities: programming and feedback. The optimal combination of mechanisms will depend on three factors: the degree to which healthcare activities are differentiated, the volume and type of interdependencies, and the level of uncertainty. Historically, healthcare services have based coordination on skills standardization and, most recently, on processes standardization, through clinical guidelines, maps, and plans.</p><p class="elsevierStyleSimplePara elsevierViewall">Their utilisation is unsatisfactory in chronic diseases involving intervention by several professionals with reciprocal interdependencies, variability in patients’ response to medical interventions, and a large volume of information to be processed. In this case, mechanisms based on feedback, such as working groups, linking professionals and vertical information systems, are more effective.</p><p class="elsevierStyleSimplePara elsevierViewall">To date, evaluation of healthcare coordination has not been conducted systematically, using structure, process and results indicators. The different strategies and instruments have been applied mainly to long-term care and mental health and one of the challenges to healthcare coordination is to extend and evaluate their use throughout the healthcare continuum.</p></span>"
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