[Barriers and facilitators to health care coordination in two integrated health care organizations in Catalonia (Spain)].
OBJECTIVE
To analyze 2 integrated delivery systems (IDS) in Catalonia and identify areas for future development to improve their effectiveness.


METHODS
An exploratory, descriptive, qualitative study was carried out based on case studies by means of document analysis and semi-structured individual interviews. A criterion sample of cases and, for each case, of documents and informants was selected. Study cases consisted of the Consorci Sanitari del Maresme (CSdM) and the Consorci Sanitari de Terrassa/Fundació Hospital Sant Llàtzer (FHSLL). A total of 127 documents were analyzed and 29 informants were interviewed: IDS managers (n = 10), technical staff (n = 5), operational unit managers (n = 5) and health professionals (n = 9). Content analysis was conducted, with mixed generation of categories and segmentation by cases and subjects.


RESULTS
CSdM and CSdT/FHSLL are health care organizations with backward vertical integration, total services production, and real (CSdM) and virtual (CSdT/FHSLL) ownership. Funds are allocated by care level. The governing body is centralized in CSdM and decentralized in CSdT/FHSLL. In both organizations, the global objectives are oriented toward improving coordination and efficiency but are not in line with those of the operational units. Both organizations present a functional structure with integration of support functions and utilize mechanisms for collaboration between care levels based on work processes standardization.


CONCLUSIONS
Both IDS present facilitators and barriers to health care coordination. To improve coordination, changes in external elements (payment mechanism) and in internal elements (governing body role, organizational structure and coordination mechanisms) are required.
Vargas Lorenzo
Ingrid
I
Servei d'Estudis i Prospectives en Polítiques de Salut, Consorci Hospitalari de Catalunya, Barcelona, España. ivargas@chc.es
Vázquez Navarrete
M Luisa
ML
D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D013030:Spain