A COMPREHENSIVE MODEL OF COOPERATION BETWEEN CAREGIVERS RELATED TO QUALITY OF CARE

Background: The system and delivery of health care tend to suffer from fragmentation, resulting in discontinuous and costly care. Local coop eration between caregivers is essential to achieve appropriate, timely , continuous and efficient care. The article develops a general compre hensive patient-centered model of quality of care related to local coo peration between caregivers. The model can be used in quality improvem ent and research. The proposed model: Within the framework of Donabedi an's triad (structure --> process --> outcome), cooperation between ca regivers is divided into two parts. Firstly, client related cooperatio n (multiple caregivers to one patient) is a part of the process of hea lth care and relevant for important quality aspects: appropriateness, timeliness, continuity of care, effectiveness and efficiency. Secondly , local cooperation between caregivers, which is not restricted to one patient, is called non client related cooperation. Such non client re lated cooperation creates conditions for optimal patient care. Non cli ent related cooperation has different degrees, dependent on the existe nce of agreements between the caregivers (such as protocols) and evalu ation of these agreements. The highest degree of non client related co operation is continuous quality improvement. To achieve a certain degr ee of non client related cooperation, conditions must be fulfilled in several fields (organization, information, financing and participants) . Applications of the model: A ''how to use the model in eight steps'' is given and possible operationalizations of key concepts in the mode l are outlined. Finally, the use of the model is illustrated by two ex amples. (C) 1997 Elsevier Science Ltd.