Abstract
Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities-Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen-collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. FOUR MULTIDISCIPLINARY REHABILITATION INTERVENTION PROGRAMMES, ONE FOR EACH CHRONIC CONDITION: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.
Highlights
Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries
Providing integrated healthcare in the Danish healthcare system is challenged by governance that is split among three entities: regions are responsible for hospitals, municipalities oversee health promotion and rehabilitation, and GPs working from private offices are patients’ main caregivers and gatekeepers [21, 22]
Three organisations—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four chronic conditions: chronic obstructive pulmonary disease (COPD), type 2 diabetes, chronic heart failure, and falls in elderly people [27]
Summary
Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs’ offices. Providing integrated healthcare in the Danish healthcare system is challenged by governance that is split among three entities: regions are responsible for hospitals, municipalities oversee health promotion and rehabilitation, and GPs working from private offices are patients’ main caregivers and gatekeepers [21, 22]. A recent paper reported that only 50% of managers and health professionals in the Danish healthcare system perceived the integration of healthcare to be satisfactory [23]
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