Community Research and Development Information Service - CORDIS


EQUITY-LA II Report Summary

Project ID: 305197
Funded under: FP7-HEALTH
Country: Spain

Periodic Report Summary 2 - EQUITY-LA II (The impact of alternative care integration strategies on Health Care Networks’ performance in different Latin American health systems)

Project Context and Objectives:
Introduction: Health services fragmentation is considered to be one of the main obstacles to attaining effective healthcare outcomes in many Latin American health systems. It produces difficulties in access to care, poor technical quality, discontinuity of care and inefficiency. Nevertheless, there is scant evidence on best practices in care coordination in Latin America. The project will build on the previous Equity-LA project (FP7-Health-2007-B) by expanding the scope of the research in Colombia and Brazil and incorporating other Latin American countries – Chile, Mexico, Argentina and Uruguay – thus representing a large array of health systems and health services networks.

General objective: to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America.

Specific objectives:
- To analyse the performance of health services networks with respect to coordination and quality of care and associated factors in each particular context
- To design, implement and benchmark a set of organizational interventions aimed at improving care coordination and quality of care with a focus on health works and patients with chronic conditions
- To test the effectiveness and limitations of the various interventions in improving coordination and quality of care in the health services networks, and to identify the factors that determine their applicability in different contexts
- To develop tools to translate evidence on best practices of care integration into innovative and effective policies for a better organization of health services networks in Latin America

Methods and analysis: A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected - intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi -structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and alter intervention (alpha=0.05; beta=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis.

Ethics: This study complies with international and national legal stipulations on ethics. Conditions of the study procedure were approved by each country’s ethical committee.

Project Results:
The first and second reporting periods include the finalization of WP1 “Theoretical framework and research tools” and WP2 “Base-line study” and the beginning of WP3 “Design and implementation of interventions”, as well as the continuation of WP6 “Capacity building and dissemination of research results” and WP7 “Project management and coordination”.

Regarding WP1, the common theoretical framework, the research plan and research tools for the qualitative data collection (topic guides) were elaborated, the study areas (intervention and control healthcare networks) selected and the context analysis (characterization of healthcare networks) finalized. Moreover, the country research teams were set up, the National Scientific Committee and the Local Steering Committee conformed, the ethical approval of the project by the ethics committees in every participating country retrieved and research capacity building activities initiated.

Regarding WP2, the qualitative data collection for the base-line study was finished in all participating Latin American countries by conducting individual interviews and focus groups with healthcare professionals, users and administrative personnel for the analysis of coordination and continuity of care and its impact on quality of care. In-depth analysis of qualitative data has been finished in nearly all countries. With reference to the quantitative base-line study, research tools (the COORDENA questionnaire for the analysis of care coordination across levels and the CCAENA questionnaire for the analysis of continuity of care across levels) were elaborated on the basis of a literature review and the existing Equity-LA tools, which were then adapted to the specific language and context of each country. Questionnaires were then improved according to the results of the pre-test which was carried out in all countries. The pilot study of the questionnaires was carried out in all the participating countries, with the support received by Beneficiary 1 (CSC). Questionnaires were then improved according to the results of the pilot study. The sample size for each survey was calculated by Beneficiary 1 and the selection process discussed with all Beneficiaries considering country specific characteristics. Support tools for the quantitative data collection and analysis were elaborated by Beneficiary 1, such as the manual for the interviewers and the coding of the open questions. Interviewers were trained for the data collection, which was finalized in all networks. Beneficiary 1 created the data bases for data entry and elaborated guidelines for the data entry. Coding and inputting was concluded in all countries. Descriptive data analysis was finalized in all but one country and reports with preliminary results were elaborated and shared with the other Beneficiaries. Research capacity building in the involved institutions continued, including specific (formal) and in-service training (learning by doing) of junior researchers by senior researchers and in-situ support by Beneficiary 1.

Regarding, WP3, first research results of the base-lines study were presented to the Local Steering Committee, health managers and professionals of the intervention and control networks in the different participating countries in Latin America. Also, a platform of heath professionals to participate in the design and implementation of the intervention was selected in each country. Then, the country research teams, together with the Local Steering Committee and the platform of professionals, selected the most relevant problems regarding coordination across care levels to be targeted during the intervention phase. On the basis of the identified and selected problems, the intervention was designed in all but one country and its implementation initiated in some countries. Beneficiary 1 elaborated a document on the general considerations for the design and implementation of the interventions and Beneficiary 2 (ITM), in charge of WP3, compiled the different reports of each country on the intervention design and the detailed plan of its implementation. Research capacity building of junior researchers and in-situ support by Beneficiary 1 and 2 continued, and capacity building of health professionals was initiated.

Regarding WP6, a dissemination strategy of the project contents and research results was elaborated. The project logotype and leaflets were designed and the project website was published and is regularly updated. The dissemination of the project contents and research results is ongoing by elaborating and publishing scientific articles and giving presentations to policy makers, researchers and other relevant stakeholders. Regarding capacity building, a strategy was developed and need assessment is ongoing. The training of the Local Steering Committee (capacity building of policy makers) is ongoing.

Finally, regarding WP7, Beneficiary 1 guided and supervised management tasks and ensured communication and information exchange between partners via telephone, e-mail and the Intranet of the project website. Furthermore, regular virtual meetings (teleconferences) are held and five international workshops (face-to-face meetings) were organized in the last two reporting periods with the participation of all Beneficiaries to discuss the project progress and to commonly prepare upcoming research activities.

Potential Impact:
The expected results of this research project will support national and international decision-makers by providing evidence of best practices in care integration in different health systems in Latin America, with particular reference to two chronic diseases (diabetes and chronic obstructive pulmonary disease (COPD). It will also contribute to advancing the state of the art by generating new knowledge on the impact of health care network reforms on coordination across care levels and, ultimately, quality of care. A dissemination strategy was developed to ensure that the findings are used to inform policy and practice and disseminated to the greater public. The following mechanisms for the management of newly generated knowledge will be considered: (1) for dissemination among the academic communities, short reports and research papers in free access peer-reviewed national and international journals and other relevant publications, as well as participation in national and international conferences; (2) to ensure that results inform policymaking: (A) a best practices report on care integration in the region and policy guidelines; (B) round tables, meetings and workshops to present key findings and policy recommendations to local and national interest groups in the six Latin American countries; (C) building networks of key contacts (academic, governmental, non-governmental, civil society, including users’ organisations, etc) in the participating countries and other countries in Latin America and elsewhere, and with international agencies, such as the PAHO, World Bank, WHO, EC, etc; and (D) coordinating with pre-established networks.

The study will further contribute to capacity building in three domains: (1) capacity building of policymakers for the planning, management and organisation of health systems by involving key stakeholders from the beginning of the project and generating evidence-based tools for the development of policy and research dissemination; (2) strengthening of research capacity of all involved institutions in health system research through the specific training of junior researchers and the exchange of knowledge and experiences among senior researchers; and (3) improvement of health professionals’ knowledge and skills in coordination across care levels and quality of care through in-service training programmes.

List of Websites:


Eduard Casadevalls, (Director Financiero)
Tel.: +34 93 2531820
Record Number: 192688 / Last updated on: 2016-12-16