title: Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol.
abstract: BACKGROUND
  Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America.
  
  
  METHODS
  A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected--intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis.
  
  
  BACKGROUND
  This study complies with international and national legal stipulations on ethics. Conditions of the study procedure were approved by each country's ethical committee. A variety of dissemination activities are implemented addressing the main stakeholders. Registration No.257 Clinical Research Register of the Santa Fe Health Department, Argentina.
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
authors.forename: María-Luisa
authors.initials: ML
authors.lastname: Vázquez
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vargas
authors.affiliation: Public Sector Care Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Unger
authors.affiliation: Public Sector Care Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: De Paepe
authors.affiliation: Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
authors.forename: Amparo Susana
authors.initials: AS
authors.lastname: Mogollón-Pérez
authors.affiliation: Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil.
authors.forename: Isabella
authors.initials: I
authors.lastname: Samico
authors.affiliation: Universidade de Pernambuco, Recife, Brasil.
authors.forename: Paulette
authors.initials: P
authors.lastname: Albuquerque
authors.affiliation: Escuela de Salud Pública Salvador Allende Gossens, Universidad de Chile, Santiago de Chile, Chile.
authors.forename: Pamela
authors.initials: P
authors.lastname: Eguiguren
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Xalapa, México.
authors.forename: Angelica Ivonne
authors.initials: AI
authors.lastname: Cisneros
authors.affiliation: Maestría en Salud Pública, Centro de Estudios Interdisciplinarios, Instituto de la Salud Juan Lazarte, Universidad Nacional de Rosario, Rosario, Argentina.
authors.forename: Mario
authors.initials: M
authors.lastname: Rovere
authors.affiliation: Facultad de Enfermería, Universidad de la República, Montevideo, Uruguay.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bertolotto
mesh_terms: D057191:Capacity Building / Q000191:economics*; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics*; D006282:Health Personnel; D006302:Health Services Research; D006801:Humans; D007843:Latin America; D065228:Non-Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires
keywords: PUBLIC HEALTH