title: Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol.
abstract: Better communication among field health care teams and points of care, together with investments focused on improving teamwork, individual management, and clinical skills, are strategies for achieving better outcomes in patient-oriented care. This research aims to implement and evaluate interventions focused on improving communication and knowledge among health teams based on points of care in a regional public health outreach network, assessing the following hypotheses: 1) A better-working communication process between hospitals and primary health care providers can improve the sharing of information on patients as well as patients' outcomes. 2) A skill-upgrading education tool offered to health providers at their work sites can improve patients' care and outcomes.
  
  
  
  A quasi-experimental study protocol with a mixed-methods approach (quantitative and qualitative) was developed to evaluate communication tools for health care professionals based in primary care units and in a general hospital in the southern region of São Paulo City, Brazil. The usefulness and implementation processes of the integration strategies will be evaluated, considering: 1) An Internet-based communication platform that facilitates continuity and integrality of care to patients, and 2) A tailored updating distance-learning course on ambulatory care sensitive conditions for clinical skills improvements. The observational study will evaluate a non-randomized cohort of adult patients, with historical controls. Hospitalized patients diagnosed with an ambulatory care sensitive condition will be selected and followed for 1 year after hospital discharge. Data will be collected using validated questionnaires and from patients' medical records. Health care professionals will be evaluated related to their use of education and communication tools and their demographic and psychological profiles. The primary outcome measured will be the patients' 30-day hospital readmission rates. A sample size of 560 patients was calculated to fit a valid logistic model. In addition, qualitative approaches will be used to identify subjective perceptions of providers about the implementation process and of patients about health system use.
  
  
  
  This research project will gather relevant information about implementation processes for education and communication tools and their impact on human resources training, rates of readmission, and patient-related outcomes.
authors: Hospital Municipal Dr. Moysés Deutsch, M'Boi Mirim, São Paulo, Brazil. mbracco.07@gmail.com.|Hospital Israelita Albert Einstein, São Paulo, Brazil. mbracco.07@gmail.com.
authors: Mario Maia
authors: MM
authors: Bracco
authors: Hospital Municipal Dr. Moysés Deutsch, M'Boi Mirim, São Paulo, Brazil.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Ana Carolina Cintra Nunes
authors: AC
authors: Mafra
authors: School of Medicine, University of São Paulo, São Paulo, Brazil.|Garoa Hacker Club, São Paulo, Brazil.
authors: Alexandre Hannud
authors: AH
authors: Abdo
authors: School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
authors: Fernando Antonio Basile
authors: FA
authors: Colugnati
authors: Secretariat of Health of Espírito Santo State, Espírito Santo, Brazil.|Superior School of Sciences of Santa Casa de Misericórdia of Vitória - EMESCAM, Vitória, Brazil.
authors: Marcello Dala Bernardina
authors: MD
authors: Dalla
authors: Paulista Medical School, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors: Marcelo Marcos Piva
authors: MM
authors: Demarzo
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Ises
authors: I
authors: Abrahamsohn
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Aline Pacífico
authors: AP
authors: Rodrigues
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Ana Violeta Ferreira de Almeida
authors: AV
authors: Delgado
authors: Center of Studies and Research Dr. João Amorim - CEJAM, Porto Alegre, Brazil.
authors: Glauber Alves
authors: GA
authors: Dos Prazeres
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: José Carlos
authors: JC
authors: Teixeira
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Silvio
authors: S
authors: Possa
mesh_terms: D000328:Adult; D001938:Brazil; D002983:Clinical Competence; D003142:Communication; D006282:Health Personnel / Q000193:education; D065386:Historically Controlled Study; D006760:Hospitalization; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D013192:Staff Development; D011795:Surveys and Questionnaires
keywords: Evidence-based implementation; Health professional education; Health system integration; Interdisciplinary communication; Primary health care