Open Access Highly Accessed Research article

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-Larsen1*, Michaela L Schiøtz1, Jeremy D Silver2, Anne Frølich3, John S Andersen4, Ilana Graetz5, Mary Reed5, Jim Bellows6, Allan Krasnik1, Thomas Rundall7 and John Hsu789

Author Affiliations

1 Section for Health Services Research, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Building 10, Stairway B; 1014 Copenhagen K, Denmark

2 Department of Biostatistics, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Building 10, Stairway B, 1014 Copenhagen K, Denmark

3 Copenhagen Hospital Cooperation, Bispebjerg Bakke 23, Bispebjerg Hospital, 2400 Copenhagen NV, Denmark

4 Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Building 24; Stairway Q, 1014 Copenhagen K, Denmark

5 Division of Research, Kaiser Permanente, 2000 Broadway; Oakland, CA 94612, USA

6 Care Management Institute, Kaiser Permanente, One Kaiser Plaza 16th Floor, Oakland, CA 94612, USA

7 University of California, Berkeley, School of Public Health, 50 University Hall Berkeley, CA 94720-7360, USA

8 Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA 02114, USA

9 Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 021115, USA

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BMC Health Services Research 2010, 10:91  doi:10.1186/1472-6963-10-91

Published: 8 April 2010

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.