Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system.
BACKGROUND
Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system.


METHODS
Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models.


RESULTS
More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration.


CONCLUSIONS
More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.
Strandberg-Larsen
Martin
M
Section for Health Services Research, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Building 10, Stairway B; 1014 Copenhagen K, Denmark. m.strandberg-larsen@ifsv.ku.dk
Schiøtz
Michaela L
ML
Silver
Jeremy D
JD
Frølich
Anne
A
Andersen
John S
JS
Graetz
Ilana
I
Reed
Mary
M
Bellows
Jim
J
Krasnik
Allan
A
Rundall
Thomas
T
Hsu
John
J
D001291:Attitude of Health Personnel; D002140:California; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards*; D003718:Denmark; D017598:Efficiency, Organizational; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008503:Medical Staff / Q000523:psychology / Q000706:statistics & numerical data; D017146:Models, Organizational; D010821:Physicians, Family / Q000523:psychology / Q000706:statistics & numerical data; D024382:Professional Role / Q000523:psychology; D011795:Surveys and Questionnaires