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      Development of a questionnaire to assess interprofessional collaboration between two different care levels

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          Abstract

          Introduction

          This paper reports the development and validation of a questionnaire to assess collaboration between clinical professionals from two different care levels (primary and specialised care), according to the clinicians’ own perceptions. This questionnaire has been elaborated to be used as part of the monitoring and evaluation process of the integrated care pilots in the public Basque Health Service.

          Methods

          The process was carried out in four phases: development of the first version of the questionnaire, validation of the content, pre-testing, and evaluation of its construct validity and homogeneity in a sample of doctors and nurses. This last phase involved confirmatory factor analysis, as well as the calculation of Cronbach’s α and various correlation coefficients.

          Results

          The process demonstrated that the theoretical content of the questionnaire was appropriate, and also that its items were clear, relevant and intelligible. The fit indices for the confirmatory factor analysis were: χ 2 of 45.51 (p=0.089), RMSEA of 0.043, RMR of 0.046, GFI of 0.92 and CFI of 0.99.

          Discussion

          The statistics indicate a good fit between the data and a conceptual two-factor structure, in which both personal relationships between professionals and characteristics of the organisational environment are understood to underlie interprofessional collaboration.

          Conclusion

          The end-product is a new instrument with good validity to assess the degree of interprofessional collaboration between clinicians working at two different levels of care.

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          Most cited references 33

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          A general structural equation model with dichotomous, ordered categorical, and continuous latent variable indicators

           Bengt Muthén (1984)
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            The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks.

            Interprofessional collaboration is a key factor in initiatives designed to increase the effectiveness of health services currently offered to the public. It is important that the concept of collaboration be well understood, because although the increasingly complex health problems faced by health professionals are creating more interdependencies among them, we still have limited knowledge of the complexity of interprofessional relationships. The goal of this literature review was to identify conceptual frameworks that could improve our understanding of this important aspect of health organizations. To this end, we have identified and taken into consideration: (A) the various definitions proposed in the literature and the various concepts associated with collaboration, and (B) the various theoretical frameworks of collaboration. Our results demonstrate that: (1) the concept of collaboration is commonly defined through five underlying concepts: sharing, partnership, power, interdependency and process; (2) the most complete models of collaboration seem to be those based on a strong theoretical background, either in organizational theory or in organizational sociology and on empirical data; (3) there is a significant amount of diversity in the way the various authors conceptualized collaboration and in the factors influencing collaboration; (4) these frameworks do not establish clear links between the elements in the models and the outputs; and (5) the literature does not provide a serious attempt to determine how patients could be integrated into the health care team, despite the fact that patients are recognized as the ultimate justification for providing collaborative care.
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              A model and typology of collaboration between professionals in healthcare organizations

              Background The new forms of organization of healthcare services entail the development of new clinical practices that are grounded in collaboration. Despite recent advances in research on the subject of collaboration, there is still a need for a better understanding of collaborative processes and for conceptual tools to help healthcare professionals develop collaboration amongst themselves in complex systems. This study draws on D'Amour's structuration model of collaboration to analyze healthcare facilities offering perinatal services in four health regions in the province of Quebec. The objectives are to: 1) validate the indicators of the structuration model of collaboration; 2) evaluate interprofessional and interorganizational collaboration in four health regions; and 3) propose a typology of collaboration Methods A multiple-case research strategy was used. The cases were the healthcare facilities that offer perinatal services in four health regions in the province of Quebec (Canada). The data were collected through 33 semi-structured interviews with healthcare managers and professionals working in the four regions. Written material was also analyzed. The data were subjected to a "mixed" inductive-deductive analysis conducted in two main stages: an internal analysis of each case followed by a cross-sectional analysis of all the cases. Results The collaboration indicators were shown to be valid, although some changes were made to three of them. Analysis of the data showed great variation in the level of collaboration between the cases and on each dimension. The results suggest a three-level typology of collaboration based on the ten indicators: active collaboration, developing collaboration and potential collaboration. Conclusion The model and the typology make it possible to analyze collaboration and identify areas for improvement. Researchers can use the indicators to determine the intensity of collaboration and link it to clinical outcomes. Professionals and administrators can use the model to perform a diagnostic of collaboration and implement interventions to intensify it.
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                Author and article information

                Contributors
                Role: Director,
                O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Kronikgune Research Group on Population Health Management
                Role: Managing Director,
                Bidasoa Integrated Healthcare Organisation, Finca Zubieta s/n, Hondarribia (Gipuzkoa), Spain, Kronikgune Research Group on Action-Research on Integrated Care
                Role: Senior Researcher,
                O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Kronikgune Research Group on Population Health Management
                Role: Director of Nursing Professional Development and Training,
                Hospital University of Navarra, Avenida Pío XII 36, Pamplona, Spain, Kronikgune Research Group on Population Health Management
                Role: Senior Researcher,
                O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Kronikgune Research Group on Population Health Management
                Journal
                Int J Integr Care
                Int J Integr Care
                IJIC
                International Journal of Integrated Care
                Igitur publishing (Utrecht, The Netherlands )
                1568-4156
                Apr-Jun 2013
                12 April 2013
                : 13
                Affiliations
                O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Kronikgune Research Group on Population Health Management
                Bidasoa Integrated Healthcare Organisation, Finca Zubieta s/n, Hondarribia (Gipuzkoa), Spain, Kronikgune Research Group on Action-Research on Integrated Care
                O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Kronikgune Research Group on Population Health Management
                Hospital University of Navarra, Avenida Pío XII 36, Pamplona, Spain, Kronikgune Research Group on Population Health Management
                O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Kronikgune Research Group on Population Health Management
                Author notes
                Correspondence to: Roberto Nuño-Solinís, O+Berri – Basque Institute for Healthcare Innovation, Plaza de Asua 1, 48950 Sondika (Bizkaia), Spain, Phone: +34 94-453-85-00, Fax: +34 94-453-04-65, www.bioef.org, E-mail: nuno@ 123456bioef.org
                ijic2013015
                3718263
                23882165
                Copyright 2013, Authors retain the copyright of their article

                This work is licensed under a ( http://creativecommons.org/licenses/by/3.0) Creative Commons Attribution 3.0 Unported License

                Categories
                Research and Theory
                Custom metadata
                Int J Integr Care 2013; Apr–Jun, URN:NBN:NL:UI:10-1-114421

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