[Factors of successful integrated care settings for total knee and hip arthroplasty: findings of a qualitative process analysis].
OBJECTIVE
In Germany, introduction of the law on Integrated Health Care (IC) (section sign 140a-d SGB V) opened up the possibility of cross-sectoral health care settings and new forms of remuneration, and improved the conditions for a closer cooperation between health care providers. However, cross-institutional and interdisciplinary work contexts demand new organizational structures in order to assure the coordination of different competences, resources and interests. This study aims at identifying factors of successful integrated care settings for total hip and knee arthroplasty. Using the example of an integrated care setting between an orthopaedic hospital and a rehabilitation clinic it will be examined which factors lead to successful implementation of the services and measures designed.


METHODS
A qualitative research design was developed comprising different methods of data assessment (participant observation, guided expert interviews, document analyses) enabling a comprehensive exploration. Overall, data were derived from six consultations with patients, two integrated care information sessions and various documents (17 patient files, information material, patient lists, etc.).


RESULTS
First of all, the different phases of development and implementation of integrated care settings were described. In this context, clearly defined aims, structures and appropriate measures seem to be crucial for an ideal long-term cooperation. Furthermore, the staff perspective on the effects of the IC programme on their daily routines proved an essential basis for process reconstruction. The staff members pointed out four main aspects regarding IC settings, i. e., improved image, increased knowledge, intensity of relationship, and less and more work effort. Against this background, factors of successful IC settings could be generated such as the need for central coordination, a regular staff information systems as well as accompanying process monitoring.


CONCLUSIONS
Several key factors of successful integrated care settings in arthroplasty could be generated which provide important clues for shaping future interdisciplinary and cross-sectoral cooperation settings in health care services in general.
Charité Campus Mitte, Abteilung für Versorgungs-systemforschung und Grundla-gen der Qualitätssicherung in der Rehabilitation Luisenstrasse, 10098, Berlin. susanne.bartel@charite.de
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D019644:Arthroplasty, Replacement, Hip / Q000331:legislation & jurisprudence* / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000331:legislation & jurisprudence* / Q000534:rehabilitation*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D001330:Electronic Data Processing; D005858:Germany; D006284:Health Plan Implementation / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D009313:National Health Programs / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000191:economics / Q000331:legislation & jurisprudence; D012984:Software