Background Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors. Methods Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. Data collection: October–December 2017. Study population: PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. Outcome variables: cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. Results The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient’s discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors. Conclusions Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination.

A high standard of quality, previous and during the study, and the inevitable contamination between groups, hindered the assessment of the marginal effectiveness of the program.

Background Cross-level clinical coordination is a priority for health systems. Evidence suggests that management integration may improve clinical coordination. This study aims to evaluate clinical coordination according to the type of management integration of the area in the Catalan health system. Methods Cross-sectional study based on the online questionnaire COORDENA-CAT (October-December 2017). Study population: primary and secondary care (acute and long term) doctors of the public Catalan health system. Sample: 3.308 doctors. Outcome variables: experience and perception of clinical coordination across care levels, knowledge and use of coordination mechanisms and related factors. Explanatory variables: area according to type of management (integrated, semi-integrated and non-integrated), demographic, employment characteristics and attitude towards work. Descriptive and multivariate analysis by robust Poisson regression. Results Better clinical coordination was observed in integrated areas compared to those semi-integrated, mostly in information transfer (PR 0.80 (95%CI 0.74-0.87)) and adequate follow-up of the patient (PR 0.89 (95%IC 0.82-0.97)). No differences were observed between integrated and non-integrated areas. General perception of coordination was higher in integrated areas than in semi-integrated and non-integrated areas (PR 0.73 (95%CI 0.63-0.84) and PR 0.85 (95%CI 0.75-0.97) respectively). Some organizational and interactional factors and the knowledge and use of coordination mechanisms showed also better results in integrated areas. There were common fields for improvement like accessibility between care levels. Conclusions No differences between integrated and non-integrated areas reveal that management integration is not enough condition to improve clinical coordination. Differences with semi-integrated areas suggest that coordination efforts should be equitable among all the providers of the territory to avoid inequalities in quality of care. Key messages Management integration does not determine clinical coordination. Cooperation formulas are needed between all territory providers that allow to fix common strategies to improve clinical coordination.

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