[Implementation of Clinical Coordination Mechanisms in Chile's Public Health System: A Scoping Review]

The implementation of care coordination mechanisms between levels of care has been one of the strategies promoted in Chile to address health system fragmentation and improve the quality of care.

To synthesize the available evidence and identify knowledge gaps regarding the implementation of clinical coordination mechanisms between levels of care in Chile's public healthcare services.

A scoping review was conducted following PRISMA guidelines, using the MEDLINE/PubMed, SCIELO, LILACS, and EPISTEMONIKOS databases between March and September 2023, with an update in August 2024. Original articles analyzing knowledge, use, or outcomes of the implementation of coordination mechanisms between levels were included.

Of the 1,001 publications identified, 11 were selected, primarily quantitative and locally scoped studies (8). Nine addressed mechanisms for clinical management coordination, such as consultations, clinical practice guidelines (CPGs), and protocols, while only two focused on information coordination mechanisms (referral, counter-referral, and discharge summaries). Five studies analyzed knowledge and use, which varied across mechanisms; referral and CPGs showed higher awareness, although the latter faced applicability and organizational barriers. Six evaluations, limited to inter-level clinical consultations and protocols, reported improvements in clinical coordination, reductions in hospitalizations, and, together with protocols, decreased waiting times. Key facilitators included participatory processes, use of technology, regulatory support, and organizational alignment.

Available knowledge on care coordination mechanisms across levels is very limited, with significant gaps in the real-world evaluation of mechanisms promoted by public policies. Although cautiously, the findings suggest that participatory approaches, those that foster professional interaction and clinical agreements, may yield better outcomes. Generating applicable and context-specific evidence should be a priority to inform policies and redesign strategies that address the persistent challenges of health system fragmentation.