Is the Kaiser Permanente model superior in terms of clinical integration?

A comparative study of Kaiser Permanente, Northern California and the Danish healthcare system

Martin Strandberg-Larsen, Michaela L. Schiøtz, Jeremy D. Silver, Anne Frølich, John S. Andersen, Ilana Yonas, Mary Reed, Jim Bellows, Allan Krasnik, Thomas Rundall, John Hsu

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Abstract. Background. Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Methods. Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. Results. More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. Conclusions. More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.

Original languageEnglish (US)
Article number91
JournalBMC Health Services Research
Volume10
DOIs
StatePublished - Apr 15 2010

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Delivery of Health Care
General Practitioners
Primary Health Care
Logistic Models
Quality of Health Care

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Is the Kaiser Permanente model superior in terms of clinical integration? A comparative study of Kaiser Permanente, Northern California and the Danish healthcare system. / Strandberg-Larsen, Martin; Schiøtz, Michaela L.; Silver, Jeremy D.; Frølich, Anne; Andersen, John S.; Yonas, Ilana; Reed, Mary; Bellows, Jim; Krasnik, Allan; Rundall, Thomas; Hsu, John.

In: BMC Health Services Research, Vol. 10, 91, 15.04.2010.

Research output: Contribution to journalArticle

Strandberg-Larsen, Martin ; Schiøtz, Michaela L. ; Silver, Jeremy D. ; Frølich, Anne ; Andersen, John S. ; Yonas, Ilana ; Reed, Mary ; Bellows, Jim ; Krasnik, Allan ; Rundall, Thomas ; Hsu, John. / Is the Kaiser Permanente model superior in terms of clinical integration? A comparative study of Kaiser Permanente, Northern California and the Danish healthcare system. In: BMC Health Services Research. 2010 ; Vol. 10.
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abstract = "Abstract. Background. Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Methods. Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. Results. More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95{\%} CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95{\%} CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95{\%} CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95{\%} CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. Conclusions. More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.",
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AU - Silver, Jeremy D.

AU - Frølich, Anne

AU - Andersen, John S.

AU - Yonas, Ilana

AU - Reed, Mary

AU - Bellows, Jim

AU - Krasnik, Allan

AU - Rundall, Thomas

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N2 - Abstract. Background. Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Methods. Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. Results. More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. Conclusions. More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.

AB - Abstract. Background. Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Methods. Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. Results. More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. Conclusions. More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.

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