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  • 51. Åhgren, Bengt
    Konkurrens och samverkan: oförenliga vårdpolitiska strategier2013In: Om samverkan: för utveckling av hälsa och välfärd / [ed] Runo Axelsson, Susanna Bihari Axelsson, Studentlitteratur AB, 2013, p. 107-118Chapter in book (Other academic)
  • 52. Åhgren, Bengt
    Konsekvensanalys av fyra scenarier om framtida akutverksamhet i Landstinget Kronoberg2007Report (Other academic)
  • 53. Åhgren, Bengt
    Managing and developing integrated care in Sweden: the unbroken chain of care2005In: Managing integrated care for older persons: European perspectives and good practices / [ed] Marja Vaarama and Richard Pieper, Helsinki: Stakes & EHMA , 2005, p. 180-199Chapter in book (Other academic)
  • 54.
    Åhgren, Bengt
    Nordic School of Public Health.
    Mutualism and antagonism within organisations of integrated health care2010In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 24, no 4, p. 396-411Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this paper is to explore the concepts of Swedish integrated health care, their state of development and interdependence, and, furthermore, evaluate whether the theoretical framework used improves the comprehension of why integrated health care arrangements endure or cease.

    DESIGN/METHODOLOGY/APPROACH: The study is founded on descriptive data gathered from a literature search on integrated health care in Sweden. With inspiration from ecology theory, these data were analysed guided by a theoretical model based on a continuum of symbiotic effects, from antagonism to mutualism.

    FINDINGS: The era of Swedish integrated health care started in the 1990s, when a kind of clinical network called chains of care was launched. At the beginning the chain of care development was predominantly surrounded by non-integrative conditions, which had a restraining effect on these efforts. Even so, it seems that chains of care are here to stay. This faith in chains of care can to some extent be explained by the crucial role they have as connectors in the emerging local health care systems. Thus, these systems need chains of care to evolve and chains of care seem to require the integrative framework of local health care to progress and endure. Integrated health care performance could be troublesome, unless such mutualistic conditions are in place. States of commensalism may also be promoted, but the advantages are unilateral and therefore there is a risk of disloyalty by the unaffected part, which, in turn, can create a breeding-ground for an antagonistic liaison.

    ORIGINALITY/VALUE: A theoretical approach founded on what may be called "Health Care System Ecology" appears to enhance the understanding of the complex logic of integrated health care.

  • 55. Åhgren, Bengt
    Mätningar av integration kan underlätta förändring2006In: Dagens medicin, ISSN 1104-7488, no 12, p. 39-Article in journal (Other academic)
  • 56. Åhgren, Bengt
    Närvård/närsjukvård: specialistvårdens omfattning på ön2007Report (Other academic)
  • 57.
    Åhgren, Bengt
    Nordic School of Public Health.
    Patient choice and health care integration: a review of the consistency between two Swedish policy concepts2010In: International Journal of Integrated Care: Volume 10, 6 December 2010, 2010Conference paper (Other academic)
    Abstract [en]

    Purpose: Despite of an insignificant track record of quasi market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as ‘choice of care’. This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is ‘local health care’, which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This paper reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible.

    Theory: Inter-organisational and interprofessional collaboration, accessibility of services, and provider continuity.

    Method: Literature-based review.

    Results and conclusions: The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a non-competitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals.

  • 58.
    Åhgren, Bengt
    Nordic School of Public Health, Göteborg, Sweden.
    The Art of Integrating Care: Theories Revisited2012In: Open Public Health Journal, ISSN 1874-9445, Vol. 5, p. 36-39Article in journal (Refereed)
    Abstract [en]

    Integration of care is high on public health agendas all around the world. The development and implementation of integrative arrangements has been promoted for more or less two decades. Despite this every so often extensive history, there are recognised needs to take research into areas yet poorly explored, which include measures and outcomes of integrated care. On the other hand, existing evidence and knowledge can probably become more ennobled and thereby contribute to a deeper understanding of the compound art of integrating of health care services. Accordingly, the aim of this article is to re-evaluate and synthesise some revisited theories for the facilitation of sustainable integrated care solutions.

    This exploration shows it is important to have crucial prerequisites for integration in place: both functional and interactional conditions. This appears to be an organic process where the stakeholders go through gradual changes until the optimum level of integration as well as mutualistic interactions are established.

    It could be argued that refined knowledge could be excerpted from existing research. Then again, this strategy does not exclude actions for new research in poorly explored areas. Both approaches are important for the development of sustainable integrated care.

  • 59.
    Åhgren, Bengt
    Nordic School of Public Health.
    The mutualism between chains of care and local care2008In: International Journal of Integrated Care – Vol. 8, 4 June 2008, 2008, p. e13-Conference paper (Other academic)
    Abstract [en]

    Introduction

    There is a growing interest in compensating for the fragmented delivery of care by promoting integrated care. This movement is a feature of national and local policy, and it is being supported and encouraged amongst care providers.

    Aims

    Discuss the concepts of Swedish integrated care and their impact on care delivery systems.

    Results

    The chain of care concept is commonly regarded as a means to make a care delivery system better adapted to the needs of patients. In many county councils, this transformation is supported by policies focusing on quality and comprehensiveness. Despite several years of experience, a vast majority of the county councils regard themselves as unsuccessful in developing chains of care.

    In addition, many county councils have changed their delivery systems during recent years and implemented ‘Local Care’, an upgraded family- and community-oriented primary care supported by a flexible hospital system. It is unusual to find a high degree of organisational cohesiveness in the implementation of local care. Instead these solutions are in many cases supposed to be built on chains of care.

    Conclusions

    Chains of care are increasingly regarded as building stones of local care, which means that chains of care are embraced in a context and by conditions more favourable than former non-integrative care delivery systems. In this sense, chains of care may have a renaissance, after assuredly being high on the policy agendas but with several years of modest development results. Thus, local care needs chains of care to evolve and chains of care need the integrative framework of local care to sustain.

  • 60. Åhgren, Bengt
    Utvärdering av Blekingesjukhuset2005Report (Other academic)
  • 61. Åhgren, Bengt
    Utvärdering av integration inom närsjukvård2007In: Folkhälsa i samverkan mellan professioner, organisationer och samhällssektorer / [ed] Runo Axelsson och Susanna Bihari Axelsson, Studentlitteratur AB, 2007, p. 305-321Chapter in book (Other academic)
  • 62.
    Åhgren, Bengt
    Nordic School of Public Health.
    Utvärdering av samverkan2007Conference paper (Other academic)
  • 63.
    Åhgren, Bengt
    Nordic School of Public Health.
    Whys and Wherefores of Integrated Health Care2008In: Integrated Health Care Delivery / [ed] Leonie A. Klein and Emily L. Neumann, Nova Science Publishers, Inc., 2008, p. 137-150Chapter in book (Other academic)
  • 64.
    Åhgren, Bengt
    Nordic School of Public Health.
    Översyn av operations- och anestesiverksamheten inom länssjukvården i Landstinget Kronoberg2004Report (Other academic)
  • 65. Åhgren, Bengt
    Översyn av operations- och anestesiverksamheten vid Länssjukhuset Ryhov2004Report (Other academic)
  • 66.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health.
    Axelsson, Runo
    Determinants of integrated health care development: chains of care in Sweden2007In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 22, no 2, p. 145-157Article in journal (Refereed)
    Abstract [en]

    Local health care in Sweden is an emerging form of integrated care, linked together by chains of care. Experiences show, however, that the development of chains of care is making slow progress. In order to study the factors behind this development, an embedded multiple-case study design was chosen. The study compared six health authorities in Sweden, three with successful and three with unsuccessful chain of care development. Three major determinants of integrated health care development were identified: professional dedication, legitimacy and confidence. In more detail, space for prime movers and trust between participants were crucial success factors, while top-down approaches targeting at the same time a change of management systems were negative for the development of chains of care. Resistance from the body of physicians was a serious obstacle to such a development. Local health care depends on developed chains of care, but it seems that health care managers do not have the management systems necessary to run these clinical networks, mainly due to a lack of acceptance from the medical profession. This is an impossible situation in the long run, since the number of chains of care is likely to increase as a result of the emerging local health care. Copyright (c) 2007 John Wiley & Sons, Ltd.

  • 67.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health.
    Axelsson, Runo
    Nordic School of Public Health.
    Evaluating integrated health care: a model for measurement2005In: International journal of integrated care, ISSN 1568-4156, Vol. 5, no Jul-Sep, p. e01-Article in journal (Refereed)
    Abstract [en]

    PURPOSE: In the development of integrated care, there is an increasing need for knowledge about the actual degree of integration between different providers of health services. The purpose of this article is to describe the conceptualisation and validation of a practical model for measurement, which can be used by managers to implement and sustain integrated care.

    THEORY: The model is based on a continuum of integration, extending from full segregation through intermediate forms of linkage, coordination and cooperation to full integration.

    METHODS: The continuum was operationalised into a ratio scale of functional clinical integration. This scale was used in an explorative study of a local health authority in Sweden. Data on integration were collected in self-assessment forms together with estimated ranks of optimum integration between the different units of the health authority. The data were processed with statistical methods and the results were discussed with the managers concerned.

    RESULTS: Judging from this explorative study, it seems that the model of measurement collects reliable and valid data of functional clinical integration in local health care. The model was also regarded as a useful instrument for managers of integrated care.

    DISCUSSION: One of the main advantages with the model is that it includes optimum ranks of integration beside actual ranks. The optimum integration rank between two units is depending on the needs of both differentiation and integration.

  • 68.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health.
    Axelsson, Runo
    Sahlgrenska Academy, Gothenburg University.
    Integrated Care: Pathfindings from Sweden2013In: Integrated care for Ireland in an international context: challenges for policy, institutions and specific service user needs / [ed] Tom O'Connor, Cork, Ireland: Oak Tree Press , 2013, p. 90-102Chapter in book (Other academic)
  • 69.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health.
    Axelsson, Susanna Bihari
    Nordic School of Public Health.
    Axelsson, Runo
    Nordic School of Public Health.
    Evaluating intersectoral collaboration: a model for assessment by service users2009In: International journal of integrated care, ISSN 1568-4156, Vol. 9, p. e03-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: DELTA was launched as a project in 1997 to improve intersectoral collaboration in the rehabilitation field. In 2005 DELTA was transformed into a local association for financial co-ordination between the institutions involved. Based on a study of the DELTA service users, the purpose of this article is to develop and to validate a model that can be used to assess the integration of welfare services from the perspective of the service users.

    THEORY: The foundation of integration is a well functioning structure of integration. Without such structural conditions, it is difficult to develop a process of integration that combines the resources and competences of the collaborating organisations to create services advantageous for the service users. In this way, both the structure and the process will contribute to the outcome of integration.

    METHOD: The study was carried out as a retrospective cross-sectional survey during two weeks, including all the current service users of DELTA. The questionnaire contained 32 questions, which were derived from the theoretical framework and research on service users, capturing perceptions of integration structure, process and outcome. Ordinal scales and open questions where used for the assessment.

    RESULTS: The survey had a response rate of 82% and no serious biases of the results were detected. The study shows that the users of the rehabilitation services perceived the services as well integrated, relevant and adapted to their needs. The assessment model was tested for reliability and validity and a few modifications were suggested. Some key measurement themes were derived from the study.

    CONCLUSION: The model developed in this study is an important step towards an assessment of service integration from the perspective of the service users. It needs to be further refined, however, before it can be used in other evaluations of collaboration in the provision of integrated welfare services.

  • 70.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health, Göteborg, Sweden.
    Nordgren, Lars
    Lunds universitet.
    Is choice of care compatible with integrated health care?: an exploratory study in Sweden2012In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 27, no 3, p. e162-e172Article in journal (Refereed)
    Abstract [en]

    Competitive and integrative policy actions are simultaneously being promoted in Swedish primary care; citizens' choice of care is launched while primary care is expected to integrate its activities with other providers for the creation of ‘local health care’. Competition tends, however, to fragment the provision of services. The aim of this study is, accordingly, to explore whether or not these policies are compatible in practice. For this purpose, strategically designed group interviews were conducted with citizens. When citizens make active choices, they are under the influence of self-perceived conditions: that is, the accessibility of the care, its continuity and the treatment offered by the care provider, conditions which, in turn, have a lot in common with the guiding principles of local health care. On the other hand, citizens who choose passively, because of not being in contact with primary care, have no difficulties in being disloyal to the chosen unit when becoming patients. In doing so, they also contribute to the fragmentation of local health care. Making entirely free choices when it comes to primary care seems to be incompatible with local health care. However, choice of care only partly equals the conditions of free choice. Choice of care and local health care would thus seem to be compatible, in practice, for the majority of patients.

  • 71. Åhgren, Bengt
    et al.
    Romberg, Rune
    Avveckling av sjukhusbolagen: Bevaras frihetsformade värden när leden rättas? - Slutrapport2004Report (Other academic)
12 51 - 71 of 71
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