Introducing coordinated care (2): evaluation of design features and implementation processes implications for a preferred health system reform model.

摘要: The study investigated why the goals of Australian Coordinated Care trials for clients with complex care needs were not achieved. Significantly higher health service use and costs incurred in absence clear evidence improved client outcomes. validity assumptions underpinning trial design success implementation at each step application model examined. There failures both implementation. Many did require coordination. funds pooling arrangements contributed to limited possibilities substitution training GP coordinators was inadequate. Trial focus on either clinical guidelines or consumer empowerment. Furthermore, expectations overall national unrealistic expected outcomes given rigidities realities system. Broader system reform form services planning regional level, based large populations, may be a more effective means address problems coordination an inflexible supply