COORDINATING PATIENT-CARE SERVICES IN REGIONAL HEALTH SYSTEMS - THE CHALLENGE OF CLINICAL INTEGRATION

Regional health systems attempting to achieve the vertical integration of health services ultimately must achieve clinical integration. The thesis of this article is that vertical integration in health care inv olves the coordination of inputs (equipment, supplies, human resources , information, and technology) and intermediate outputs (preventive, d iagnostic, acute, chronic, and rehabilitative services) to attain the end goal of optimal personal health. Given this perspective on vertica l integration, the coordination of specialty services and primary care within a system structure-that is, the clinical integration of patien t care-is central to the realization of vertically integrated regional health systems. Institution-level and environmental factors that faci litate and challenge the attainment of clinical integration are elucid ated, and a set of clinical integrating mechanisms are outlined with p resentation of real-world examples of those mechanisms. The analysis c oncludes by summarizing the next steps in realizing the vision of clin ically integrated, regional systems of health care.