IRPP Session 6- Case Studies and Lessons from Abroad Integration of services for frail elderly- SIPA and PRISMA projects and after Céline Bureau, M.Sc.Inf. (cbureau.csss-iugs@msss.gouv.qc.ca) CSSS-IUG de Sherbrooke 3 avril 2009
Plan What was experimented What was learned And now what? Conclusion
Plan What was experimented What was learned And now what? Conclusion
SIPA (1998) and PRISMA (2001) SIPA: Programme de recherche sur les services intégrés aux personnes âgées www.solidage.ca PRISMA: Programme de recherche sur l intégration des services de maintien de l autonomie www. prismaquebec.qc.ca Community-based primary care model Case management Public governance
SIPA and PRISMA SIPA Full integration system (Leutz 1999) Components: community based multidiscilinary team with full clinical responsibility for delivering care (community, hospital, nursing home); capitation; case management; clinical guidelines Experimental design: 1207 personnes (606 experimental- 601 control) 2 urban areas PRISMA Coordination type Integrated Delivery System (Leutz 1999) Components: coordination og organizations, single entry, single assesment instrument, case management, individualised service plan, computerized clinical chart Quasi-experimental design (population based): 1501 persons identified at risk (728 experimental- 773 comparison) 2 urban and 4 rural areas
SIPA and PRISMA: results SIPA increased accessibility to home care; reduction of hospital use for long term care; no significant differences for utilization and cost of hospital use; no differences of total overall costs; increased satisfaction; no increased of caregiver burden or out-of pocket costs; as expected, no differences in health outcomes PRISMA measurement of the implementation rate; lower functional decline; satisfaction and empowerment significantly higher; lower number of ER and hospitalisations than expected
What was learned Integration is feasible and brings improvements
What was learned Integration is feasible and brings improvements Family doctors are poorly integrated in the system
What was learned Integration is feasible and brings improvements Family doctors are poorly integrated in the system The need for common tools
Common tools
What was learned Integration is feasible and brings improvements Family doctors are poorly integrated in the system The need for common tools The research and practice tandem: a must
Tandem research and practice Decide Act Monitor-Evaluate Adjust
And now what?
Composantes de l intégration (MSSS Orientations, 2001) Administratives : 1. Concertation entre les organisations 2. Budget consolidé, par programme-services 3. Responsable du réseau Organisationnelles : 4. Guichet unique d accès aux services de longue durée (domicile et hébergement) 5. Système commun d évaluation et de classification (OEMC, SMAF et profil iso-smaf), des trajectoires 6. Dossier clinique informatisé partageable Cliniques : 7. Intervenant pivot du réseau, médecin, équipe locale et équipes spécialisées 8. Des protocoles, des cheminements cliniques 9. Plan de services individualisé
And now what? Monitor the implementation of Integrated Network
And now what? Monitor the implementation of Integrated Network Increase family doctor involvment (access, interprofessional collaboration, incentives)
And now what? Monitor the implementation of Integrated Network Increase family doctor involvment (access, interprofessional collaboration, incentives) Clarify the hierachy of services (1st line and 2 nd line)
And now what? Monitor the implementation of Integrated Network Increase family doctor involvment (access, interprofessional collaboration, incentives) Clarify the hierachy of services (1st line and 2 nd line) Formation: behavior associated with cognitive impairments; case management; care of the elderly in basic education
And now what? Monitor the implementation of Integrated Network Increase family doctor involvment (access, interprofessional collaboration, incentives) Clarify the hierachy of services (1st line and 2 nd line) Formation: behavior associated with cognitive impairments; case management; care of the elderly in basic education Partner with private residences: contracts; accreditation
La certification des RPA
And now what? Monitor the implementation of Integrated Network Increase family doctor involvment (access, interprofessional collaboration, incentives) Clarify the hierachy of services (1st line and 2 nd line) Formation: behavior associated with cognitive impairments; case management; care of the elderly in basic education Partner with private residences: contracts; accreditation Partner with the caregiver: early; choice; respite.
Conclusion The local services network
Conclusion The local services network The shared responsability for the improvement of the health of the community
Mise en place de modèle favorable à l approche populationnelle : Ex. : «Expanded chronic care model» Élaborer politiques Santé publique Créer environnement favorable Renforcer actions communauté Communauté active Partenaires communautaires formés et proactifs «Expanded chronic care model», BARR et coll, 2001 Résultats cliniques et fonctionnels Résultats santé populationnelle
Thank you cbureau.csss-iugs@ssss.gouv.qc.ca