[Perceived needs of health personnel in the provision of healthcare to the immigrant population]. / Necesidades de los profesionales de salud en la atención a la población inmigrante.

OBJECTIVE: To analyze the needs perceived by health personnel in the provision of healthcare to the immigrant population and to provide suggestions for improvement. METHODS: A descriptive, exploratory and phenomenological qualitative study was carried out by means of semi-structured individual interviews and focus groups to a criterion sample of informants: healthcare managers (n=21) and health professionals (n=44) from primary and specialized care. A narrative content analysis was conducted by three analysts, segmented by groups of informants and themes, with mixed generation of categories. RESULTS: The need for support in providing healthcare to the immigrant population strongly emerged in the informants' discourses, with some discrepant voices. On the one hand, translated materials, translation services, and a greater length of time allocated per patient, were required to address communication and information barriers. On the other hand, specific training focusing on cultural aspects and practical tools for immediate implementation were needed to provide adequate care to patients from diverse cultural backgrounds. In addition, changes in the healthcare system, led by the Health Department, were requested to adapt resources to the new situation. CONCLUSION: The needs identified for support in communication, information and training, as well as changes in the system, reveal the insufficient implementation of the interventions contemplated in the Immigration and Health Plan. In addition, structural and organizational deficiencies were identified that should be addressed by general policies.

[Impact of a capitation payment system on healthcare coordination]. / Impacto de un sistema de compra capitativo en la coordinación asistencial.

OBJECTIVE: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective. METHODS: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants' groups, themes, and areas. The study area consisted of the 5 pilot zones. RESULTS: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty, providers' fears of losing their identity, lack of interest, and the management limits of some providers. CONCLUSIONS: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia.

[Coordination among healthcare levels: systematization of tools and measures]. / La coordinación entre niveles asistenciales: una sistematización de sus instrumentos y medidas.

Improving healthcare coordination is a priority in many healthcare systems, particularly in chronic health problems in which a number of professionals and services intervene. There is an abundance of coordination strategies and mechanisms that should be systematized so that they can be used in the most appropriate context. The present article aims to analyse healthcare coordination and its instruments using the organisational theory. Coordination mechanisms can be classified according to two basic processes used to coordinate activities: programming and feedback. The optimal combination of mechanisms will depend on three factors: the degree to which healthcare activities are differentiated, the volume and type of interdependencies, and the level of uncertainty. Historically, healthcare services have based coordination on skills standardization and, most recently, on processes standardization, through clinical guidelines, maps, and plans. Their utilisation is unsatisfactory in chronic diseases involving intervention by several professionals with reciprocal interdependencies, variability in patients' response to medical interventions, and a large volume of information to be processed. In this case, mechanisms based on feedback, such as working groups, linking professionals and vertical information systems, are more effective. To date, evaluation of healthcare coordination has not been conducted systematically, using structure, process and results indicators. The different strategies and instruments have been applied mainly to long-term care and mental health and one of the challenges to healthcare coordination is to extend and evaluate their use throughout the healthcare continuum.

[Improving our mobility in Europe: The EHTAN Project]. / Mejorar nuestra movilidad en Europa Proyecto EHTAN.

To promote the mobility of nursing professionals among the countries members of the European Union may be an efficient measure to alleviate the shortage of nurses. An important limitation for this mobility consists in the lack of knowledge about the different cultures and with regards to the competencies, formation and nursing practices which exist in these distinct countries. At the present time, there is no method or instrument available which permits a comparison. The EHTAN, the European Healthcare Teaching and Accreditation Network, project proposes a methodology to evaluate and self-evaluate competencies by means of a tool, a competency matrix, developed for this purpose. In this article, the authors introduce the work carried out during the first phases of this project.

[Integrated health care organizations: guideline for analysis]. / Organizaciones sanitarias integradas: una guía para el análisis.

There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.

Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies.

Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants' access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented.

Health policies for migrant populations in three European countries: England; Italy and Spain.

OBJECTIVES: The study aimed at providing a comparative analysis of health policies for immigrant populations in three European countries. METHODS: A descriptive comparative study of health policies for immigrant population was conducted through content analysis. England, Italy and Spain were selected because they have similar national health systems and different histories of immigration. For each country national or regional plans that included health policies for immigrants or ethnic minorities were selected. The analysis was conducted along the following dimensions: policy objectives, strategies, and evaluation of results. Subsequently, strategies were categorized according to the field of action. RESULTS: Improvements in immigrants' health are the ultimate objectives of these policies but they differ in emphasis and strategies. Main strategies relate to: addressing specific health issues; access to healthcare - information, communication, service supply and administrative proceedings; and improving quality of healthcare provision - services adaptation, professionals training and health needs' analysis. Only in England are some results of policy evaluation available. CONCLUSIONS: Different models of immigrant integration in receiving countries seem to condition the health policy approach. England and Spain propose actions to address immigrants' healthcare needs, while in Italy the development of specific strategies is limited.

Health professional perceptions regarding healthcare provision to immigrants in Catalonia.

OBJECTIVES: To analyse health personnel perceptions regarding the provision of care to immigrant population. METHODS: An exploratory and descriptive qualitative study was carried out by means of semi-structured individual interviews and focus groups to a theoretical sample of informants: Healthcare managers (19) and health professionals (46) from primary and secondary care. Narrative content analysis was conducted, segmented by informants' groups and themes. The area of study was five regions (comarcas) of Catalonia (Spain). RESULTS: Having to provide healthcare to immigrants generates feelings of distress, overload and exhaustion in health professionals, particularly in primary care personnel. However, problems faced in providing care were identified both by professionals and managers. Communication barriers emerged as the main problem. Other problems were attributed to specific characteristics of immigrants, their inappropriate use of services and professionals' attitudes. Structural and organizational deficiencies of the health system also emerged. CONCLUSIONS: For health professionals in Catalonia to provide care of quality to immigrants, interventions that reduce communication barriers and improve their cultural competences are requested. In addition, structural changes are needed to adapt the Catalonian health care system to the new circumstances.

Perception of the Ecuadorian population living in Barcelona regarding access to health services.

OBJECTIVES: To analyse the factors that influence access to health services from the point of view of the Ecuadorian population living in Barcelona. METHODS: A qualitative, descriptive and phenomenological study was carried out by semi-structured individual interviews on a sample of Ecuadorians (18) with maximum variation in age, sex, time since arrival and administrative status. The analysis was conducted according to Colaizzi's method. The study area was Barcelona. RESULTS: Access was considered to be easy for personal health-care card (PHC) holders. However, interviewees identified few factors that facilitated access related to the Ecuadorian population (PHC holder, language, social networks) and the health system (free care, opening hours). In contrast, a number of hindering factors related to both the Ecuadorian population (insufficient knowledge of the system, problems with the documentation in obtaining the PHC, working conditions) and to the system itself (information availability, resources, organisation, attitude of staff) were also identified. CONCLUSIONS: Although access was perceived as easy, the Ecuadorian population has to overcome a number of barriers to obtain care. These obstacles may have consequences on immigrants' health and on the efficiency of the system.

[Health policies of national and regional level for the immigrant population in Spain]. / Políticas sanitarias de ámbito estatal y autonómico para la población inmigrante en España.

OBJECTIVES: To analyze the content of health policies for the immigrant population developed by central and regional governments in Spain. METHODS: A descriptive comparative study of central and regional healthcare policies for the immigrant population was conducted in Spain through content analysis. The selected regions were Andalusia, Valencia, Madrid and the Basque Country as these regions have specific policies, distinct proportions of immigrants and policy evaluations. National or regional health and immigration plans with health policies for immigrants were selected. Contents analysis was conducted of the following main dimensions: policy principles and objectives, strategies and results' evaluation. Subsequently, strategies were categorized according to the area of intervention. RESULTS: Healthcare policies for the immigrant population are mainly included in national and regional immigration plans. The principles of these policies are based on equal rights to healthcare between the immigrant and native-born populations and the objectives aim to achieve this end. National objectives and actions address access to and adaptation of health services, health promotion, health needs assessment, and health personnel training in cultural competences. Regional policies follow the national guidelines but their actions are more specific. Policy evaluations are highly limited. CONCLUSIONS: The content of the health policies, especially national policies, address major issues in meeting immigrants' healthcare needs. However, the absence of assessments, together with persistent problems in the provision of care and inequalities in access, could indicate insufficient implementation and requires careful monitoring.

Políticas sanitarias de ámbito estatal y autonómico para la población inmigrante en España / Health policies of national and regional level for the immigrant population in Spain

Objetivos Analizar el contenido de las políticas sanitarias estatales y autonómicas dirigidas a inmigrantes en España.MétodosSe realizó un estudio comparativo descriptivo de las políticas sanitarias para inmigrantes, estatales y autonómicas, mediante análisis de contenido. Se seleccionaron Andalucía, Comunidad Valenciana, Comunidad de Madrid y País Vasco por tener políticas específicas, proporción diferente de inmigrantes y evaluación de la política. Se seleccionaron planes estatales o autonómicos con intervenciones sanitarias dirigidas a inmigrantes. Se realizó un análisis de contenido cuyas dimensiones iniciales fueron: principios, objetivos, estrategias y evaluación. Posteriormente se clasificaron las estrategias según el ámbito de actuación.ResultadosLas políticas sanitarias dirigidas a inmigrantes se definen principalmente en los planes de inmigración. Los principios se basan en la igualdad de derechos en salud con la población autóctona, y los objetivos se dirigen a su consecución. Buena parte de las acciones están encaminadas a la mejora del acceso a la atención. Además, contemplan estrategias específicas para adaptación de los servicios, promoción de la salud, análisis de las necesidades y formación de los profesionales. Las políticas autonómicas siguen las directrices generales marcadas para todo el Estado, pero con acciones más concretas. Las evaluaciones de las políticas son muy limitadas.ConclusiónEl contenido de las políticas sanitarias, especialmente estatales, responden a aspectos importantes a considerar en la atención a la población inmigrante. Sin embargo, la ausencia de evaluaciones, junto a la persistencia de problemas en la atención e inequidades en el acceso, podría indicar una insuficiente implantación y requiere un seguimiento cuidadoso(AU)

ObjectivesTo analyze the content of health policies for the immigrant population developed by central and regional governments in Spain.MethodsA descriptive comparative study of central and regional healthcare policies for the immigrant population was conducted in Spain through content analysis. The selected regions were Andalusia, Valencia, Madrid and the Basque Country as these regions have specific policies, distinct proportions of immigrants and policy evaluations. National or regional health and immigration plans with health policies for immigrants were selected. Contents analysis was conducted of the following main dimensions: policy principles and objectives, strategies and results’ evaluation. Subsequently, strategies were categorized according to the area of intervention.ResultsHealthcare policies for the immigrant population are mainly included in national and regional immigration plans. The principles of these policies are based on equal rights to healthcare between the immigrant and native-born populations and the objectives aim to achieve this end. National objectives and actions address access to and adaptation of health services, health promotion, health needs assessment, and health personnel training in cultural competences. Regional policies follow the national guidelines but their actions are more specific. Policy evaluations are highly limited.ConclusionsThe content of the health policies, especially national policies, address major issues in meeting immigrants’ healthcare needs. However, the absence of assessments, together with persistent problems in the provision of care and inequalities in access, could indicate insufficient implementation and requires careful monitoring(AU)

Necesidades de los profesionales de salud en la atención a la población inmigrante / Perceived needs of health personnel in the provision of healthcare to the immigrant population

ObjetivoAnalizar las necesidades de apoyo expresadas por el personal sanitario en la atención al colectivo inmigrante y aportar sugerencias de mejora.MétodosEstudio cualitativo, descriptivo, de carácter exploratorio y fenomenológico. Se llevaron a cabo entrevistas individuales semiestructuradas y grupos focales en una muestra teórica de informantes: directivos de proveedores (21) y profesionales de primaria y especializada (42). Se hizo un análisis narrativo del contenido con generación mixta de categorías y segmentación por grupo de informantes y temas.ResultadosEn el discurso de los informantes emergen con fuerza diversas necesidades de apoyo para la atención a la población inmigrante, con algunas voces discrepantes. Por un lado, para superar las barreras a la comunicación e información se requieren materiales en diversos idiomas y servicios de traducción, así como más tiempo por paciente. Por otro lado, para proveer atención a pacientes con culturas diversas se requiere formación centrada en aspectos culturales y de carácter práctico con aplicación inmediata. Además, para adaptar los recursos a la nueva situación, destaca la necesidad de introducir cambios en el sistema sanitario, liderados por el Departament de Salut.ConclusiónLas necesidades identificadas de apoyo para la comunicación, la información y la formación, así como de cambios en el sistema, indican que las intervenciones contempladas en el Plan Director de Inmigración en Salud no son debidamente implantadas, pero además se observan deficiencias estructurales y organizativas que deberían abordarse mediante políticas generales(AU)

ObjectiveTo analyze the needs perceived by health personnel in the provision of healthcare to the immigrant population and to provide suggestions for improvement.Methods A descriptive, exploratory and phenomenological qualitative study was carried out by means of semi-structured individual interviews and focus groups to a criterion sample of informants: healthcare managers (n=21) and health professionals (n=44) from primary and specialized care. A narrative content analysis was conducted by three analysts, segmented by groups of informants and themes, with mixed generation of categories.ResultsThe need for support in providing healthcare to the immigrant population strongly emerged in the informants’ discourses, with some discrepant voices. On the one hand, translated materials, translation services, and a greater length of time allocated per patient, were required to address communication and information barriers. On the other hand, specific training focusing on cultural aspects and practical tools for immediate implementation were needed to provide adequate care to patients from diverse cultural backgrounds. In addition, changes in the healthcare system, led by the Health Department, were requested to adapt resources to the new situation.ConclusionThe needs identified for support in communication, information and training, as well as changes in the system, reveal the insufficient implementation of the interventions contemplated in the Immigration and Health Plan. In addition, structural and organizational deficiencies were identified that should be addressed by general policies(AU)

Impacto de un sistema de compra capitativo en la coordinación asistencial / Impact of a capitation payment system on healthcare coordination

Objetivo: Evaluar desde una perspectiva cualitativa el impacto sobre la coordinación asistencial de la prueba piloto del sistema de compra capitativo en Cataluña.Métodos: Estudio cualitativo, exploratorio y descriptivo, mediante análisis de documentos y entrevista individual, con muestreo teórico de documentos e informantes: directivos del comprador(9), directivos de los proveedores (26), profesionales(16). Análisis de contenido, con generación mixta de categorías y segmentación por grupos de informantes, temas y áreas. El área de estudio la constituyeron las 5 zonas piloto.Resultados: La prueba facilitó, según los informantes, una visión conjunta del territorio y mejoró la comunicación. No obstante, los cambios introducidos a partir de la prueba para mejorar la coordinación asistencial fueron escasos. Se estableció una única alianza virtual entre proveedores de un territorio,con objetivos compartidos y cambios estructurales. En general, se intercambiaron los mecanismos de coordinación asistencial existentes, con un uso variable. La incertidumbre de la prueba, el temor a perder la identidad, el limitado interés ylos límites de gestión de algunos proveedores se percibían como barreras al cambio.Conclusiones: El sistema de compra capitativo, diseñado yejecutado, no generó incentivos suficientes para desencadenar cambios en la coordinación asistencial. Sería necesario corregir las debilidades identificadas en la evaluación antes de extender la prueba al resto de Cataluña

Objective: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective.Methods: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants’ groups, themes, and areas. The study area consisted of the 5 pilot zones.Results: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty,providers’ fears of losing their identity, lack of interest, and the management limits of some providers.Conclusions: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia

La coordinación entre niveles asistenciales: una sistematización de sus instrumentos y medidas / Coordination among healthcare levels: systematization of tools and measures

La mejora de la coordinación asistencial es una prioridad para muchos sistemas de salud y, especialmente, para la atención de problemas de salud crónicos en los que intervienen múltiples profesionales y servicios. La abundancia de estrategias y mecanismos de coordinación promovidos requiere una sistematización que ayude a utilizarlos de forma adecuada. El objetivo del artículo es analizar la coordinación asistencial y sus instrumentos, a partir de la teoría organizacional. Los mecanismos se pueden clasificar según el proceso básico utilizado para la coordinación de las actividades, programación o retroalimentación. La combinación óptima de mecanismos dependerá de 3 factores: grado de diferenciación de las actividades asistenciales, volumen y tipo de interdependencias y grado de incertidumbre. Históricamente, los servicios sanitarios han confiado la coordinación a la estandarización de las habilidades y, de manera más reciente, de los procesos mediante guías, mapas y planes. Su utilización resulta insuficiente para enfermedades crónicas en las que intervienen diversos profesionales con interdependencias recíprocas, variabilidad en la respuesta y un volumen de información procesada elevado. En este caso, son más efectivos los mecanismos basados en la retroalimentación, como grupos de trabajo, profesionales de enlace y sistemas de información vertical. La evaluación de la coordinación asistencial ha sido realizada hasta el momento de forma poco sistemática, mediante la utilización de indicadores de estructura, proceso y resultado. Las diversas estrategias e instrumentos se han aplicado, sobre todo, en los niveles sociosanitario y de salud mental; uno de los retos para la coordinación es extender y evaluar su uso a lo largo del continuo asistencial

Improving healthcare coordination is a priority in many healthcare systems, particularly in chronic health problems in which a number of professionals and services intervene. There is an abundance of coordination strategies and mechanisms that should be systematized so that they can be used in the most appropriate context. The present article aims to analyse healthcare coordination and its instruments using the organisational theory. Coordination mechanisms can be classified according to two basic processes used to coordinate activities: programming and feedback. The optimal combination of mechanisms will depend on three factors: the degree to which healthcare activities are differentiated, the volume and type of interdependencies, and the level of uncertainty. Historically, healthcare services have based coordination on skills standardization and, most recently, on processes standardization, through clinical guidelines, maps, and plans. Their utilisation is unsatisfactory in chronic diseases involving intervention by several professionals with reciprocal interdependencies, variability in patients' response to medical interventions, and a large volume of information to be processed. In this case, mechanisms based on feedback, such as working groups, linking professionals and vertical information systems, are more effective. To date, evaluation of healthcare coordination has not been conducted systematically, using structure, process and results indicators. The different strategies and instruments have been applied mainly to long-term care and mental health and one of the challenges to healthcare coordination is to extend and evaluate their use throughout the healthcare continuum

Organizaciones sanitarias integradas: una guía para el análisis / Integrated health care organizations: guideline for analysis

There has been a tendency recently to abandon competition andto introduce policies that promote collaboration between health providersas a means of improving the efficiency of the system and thecontinuity of care. A number of countries, most notably the UnitedStates, have experienced the integration of health care providers tocover the continuum of care of a defined population. Catalonia haswitnessed the steady emergence of increasing numbers of integratedhealth organisations (IHO) but, unlike the United States, studies onhealth providers' integration are scarce. As part of a research projectcurrently underway, a guide was developed to study Catalan IHOs,based on a classical literature review and the development of a theoreticalframework. The guide proposes analysing the IHO's performancein relation to their final objectives of improving the efficiencyand continuity of health care by an analysis of the integration type(based on key characteristics); external elements (existence of othersuppliers, type of services' payment mechanisms); and internal elements(model of government, organization and management) thatinfluence integration. Evaluation of the IHO's performance focuseson global strategies and results on coordination of care and efficiency.Two types of coordination are evaluated: information coordinationand coordination of care management. Evaluation of the efficiencyof the IHO refers to technical and allocative efficiency. Thisguide may have to be modified for use in the Catalan context

There has been a tendency recently to abandon competition andto introduce policies that promote collaboration between health providersas a means of improving the efficiency of the system and thecontinuity of care. A number of countries, most notably the UnitedStates, have experienced the integration of health care providers tocover the continuum of care of a defined population. Catalonia haswitnessed the steady emergence of increasing numbers of integratedhealth organisations (IHO) but, unlike the United States, studies onhealth providers' integration are scarce. As part of a research projectcurrently underway, a guide was developed to study Catalan IHOs,based on a classical literature review and the development of a theoreticalframework. The guide proposes analysing the IHO's performancein relation to their final objectives of improving the efficiencyand continuity of health care by an analysis of the integration type(based on key characteristics); external elements (existence of othersuppliers, type of services' payment mechanisms); and internal elements(model of government, organization and management) thatinfluence integration. Evaluation of the IHO's performance focuseson global strategies and results on coordination of care and efficiency.Two types of coordination are evaluated: information coordinationand coordination of care management. Evaluation of the efficiencyof the IHO refers to technical and allocative efficiency. Thisguide may have to be modified for use in the Catalan context

En los últimos años se observa una tendencia a abandonar lacompetencia e introducir políticas que favorezcan la colaboraciónentre proveedores de salud como vía para mejorar la eficiencia delsistema y la continuidad de la atención sanitaria. Distintos países handesarrollado experiencias con la integración de proveedores paraproporcionar el continuo asistencial a una población definida, principalmenteen Estados Unidos. En Cataluña han surgido progresivamenteorganizaciones sanitarias integradas (OSI) pero los estudiossobre integración son escasos, a diferencia con los Estados Unidos.Como parte de una investigación que se está llevando a cabo, se desarrollóuna guía para el estudio de las OSI catalanas a partir de unarevisión sistemática clásica de la literatura y de la elaboración de unmarco teórico. La guía propone el análisis del desempeño de las OSIen relación a sus objetivos finales de mejora de la eficiencia y continuidadde la atención mediante el análisis del tipo de integración (apartir de las características clave), de elementos del entorno (existenciade otros proveedores, tipo de mecanismos de pago de la provisión)e internos (modelo de gobierno, organización y gestión) queinfluyen la integración. La evaluación de desempeño de las OSIvalora las estrategias globales, así como los resultados de coordinaciónasistencial y eficiencia. Se evalúa la coordinación de la informacióna través de la red y de la gestión de la atención. El análisis dela eficiencia de la OSI se refiere a la eficiencia técnica y asignativa.El uso de esta guía en el contexto catalán puede requerir adaptaciónadicional

Mejorar nuestra movilidad en Europa. Proyecto Ehtan / Improving our mobility in Europe. The Ehtan Project

Fomentar la movilidad de profesionales de enfermería entre los países de la Unión Europea (EU), puede ser un medio eficaz para paliar la escasez de enfermeras. Una limitación importante para dicha movilidad consiste en el desconocimiento de las diferencias culturales y en cuanto a competencias, formación y práctica de enfermería entre los distintos países. Actualmente no existe un método o instrumento que permita la comparación. El proyecto de la Red Europea de Formación y Acreditación Sanitaria (EHTAN) propone una metodología de valoración y auto-evaluación de competencias a través de un instrumento elaborado para este fin. En este artículo, se presenta el trabajo realizado durante las primeras fases del proyecto

To promote the mobility of nursing professionals among the countries members of the European Union may be an efficient measure to alleviate the shortage of nurses. An important limitation for this mobility consists in the lack of knowledge about the different cultures and with regards to the competencies, formation and nursing practices which exist in these distinct countries. At the present time, there is no method or instrument available which permits a comparison. The EHTAN, the European Healthcare Teaching and Accreditation Network, project proposes a methodology to evaluate and self-evaluate competencies by means of a tool, a competency matrix, developed for this purpose. In this article, the authors introduce the work carried out during the first phases of this project