Integration of healthcare rehabilitation in chronic conditions.
BACKGROUND
Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities-Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen-collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions.
FOUR MULTIDISCIPLINARY REHABILITATION INTERVENTION PROGRAMMES, ONE FOR EACH CHRONIC CONDITION: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes.


CONCLUSIONS
The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.
Frølich
Anne
A
Department of Integrated Healthcare, Copenhagen Hospital Cooperation, Bispebjerg Bakke 23, Bispebjerg Hospital, DK-2400 Copenhagen NV, Denmark and Department of Health Services Research, Institute of Public Health, University of Copenhagen Øster Farimagsgade 5, Building 10, Ground Floor, DK-1014 Copenhagen K, Denmark.
Høst
Dorte
D
Schnor
Helle
H
Nørgaard
Annette
A
Ravn-Jensen
Cecilia
C
Borg
Eva
E
Hendriksen
Carsten
C