title: The importance of normative integration in stroke services: case study evidence from Sweden and England.
abstract: OBJECTIVE
  A number of evidence-based interventions are now available for stroke patients. Good-quality stroke care involves a range of health professionals located across ambulance, hospital, community and primary care services. This study examined the perspectives of health-care workers involved in stroke care in Sweden and England on the integration challenges stroke care presents.
  
  
  METHODS
  Four qualitative case studies were carried out in Sweden and England, including 95 semistructured interviews with clinicians and managers associated with four different hospitals providing specialized stroke services.
  
  
  RESULTS
  High levels of organizational, functional, service and clinical integration among clinicians that deliver emergency and acute stroke care were identified. This is frequently lacking among professionals delivering postacute care. These findings are linked to the prevalence or lack of normative and systemic integration in each respective stage of care.
  
  
  CONCLUSIONS
  Emphasis on the need to treat stroke as an emergency condition in both countries has created a context in which normative and systemic integration often occurs among clinicians that deliver emergency and acute stroke care, aiding the development of organizational, functional, service and clinical integration across the case study sites. In contrast, integration between hospital and community (rehabilitation and general practice) care is frequently less successful.
authors.affiliation: Department of Management, King's College London, 150 Stamford Street, London SE1 9NH, UK. Juan.baeza@kcl.ac.uk
authors.forename: Juan I
authors.initials: JI
authors.lastname: Baeza
authors.forename: Annette
authors.initials: A
authors.lastname: Boaz
authors.forename: Alec
authors.initials: A
authors.lastname: Fraser
authors.forename: Naomi
authors.initials: N
authors.lastname: Fulop
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
authors.forename: Charles
authors.initials: C
authors.lastname: Wolfe
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration; D004630:Emergencies; D004739:England; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D020521:Stroke / Q000628:therapy*; D013548:Sweden