Integrating services for frail older people: the PRISMA Coordination Model

Implementation and Impact in Québec, Canada

Michel Raîche, MSc, PhD (c)

Réjean Hébert, and the PRISMA Group

Research Centre on Aging, Université de Sherbrooke, Québec, Canada

Programme of Research to

Integrate the Services for the

Maintenance of Autonomy

Content

• Introduction on Québec health system : context, problems, solution

• Description of the PRISMA model– 6 components

• Implementation evaluation

• Evaluation of population impacts

• Lessons learned and recommendations

Geographical location

**SherbrookeSherbrooke

Demographic characteristics(Province of Québec)

0

5

10

15

20

25

30

% >

65yo

1992 2015 2040

• Tot pop. : 7.4 million• >65yo: 0.9 million• 30% disabilities and

need for long-term services– at home

– intermediate facilities

– in LTC institutions (4%)

Québec social & health system

• Free, Universal, Accessible• Social services AND Health : one Ministry• Coverage

– medical services (hospital & clinics)– nursing (home, hospital, LTC facilities)– medication

• Ministry of health: insurer, manager & services dispenser

CSSS (HSSC)Centres de santé et services sociauxHealth and Social Services Centers

• 95 covering all the territory– rural areas– small cities (100 000)– district of large cities

• Governed by a board (partially elected)

• Responsible for Primary care – prevention and health promotion– treatment– rehabilitation

CSSS Services

• Current services

– medical

– nursing

– psychosocial services

– Info-Health (telephone, 7/7, 24h/d)

• Programmes

– Maternal/Child/Family/Youth

– Mental health

– Work health

– Home services

CSSS Home services programme

• Standard Assessment– SMAF (Functional Autonomy Measurement System)

• 2 programmes– regular – intensive (>5 hours per week)

• Caregivers– CSSS's employees (mainly)– private agencies– direct allocation

CSSS: Home services

• Medical (coll. with private prac. Physicians)

• Nursing care

• Personal care & domestic assistance

• Psychosocial services

• Rehabilitation (physio, occ therapy)

• Nutrition

Other home support services

• Voluntary groups (ex.: Meals on wheels)

• Social Economy Enterprises (domestic)

• Temporary institutionalisation (respite)– planned– crisis

Institutions

• Admission mechanism– standard assessment

(SMAF)– coordinated locally

• 3 types– Family-type residences

(<10 residents)– Intermediate Facilities

(10 +)– LTC facilities

Geriatric Services

• Out-patient Geriatric Clinic

• Assessment Unit

• Rehabilitative Unit

• Day Hospital

• Day Center

• Psychogeriatric services

Summary

Geriatric ServicesTemporaryInstitutionalisation

CSSSHome Care

Voluntary Services

General and specialisedHospitals

Admission Coordination

DefinitiveInstitutionalisation

Social Economy Enterprises

Problems

• Multiple entry points• Services determined by the provider rather than

the needs• Multiple redundant assessments (different tools)• Inappropriate utilization of costly resources• Hospital-home transitions• Delays for getting services• Information sharing• Partial response to the needs

Continuity of services

• Short-term (between services)– coordination and integration of services

• Long-term– adaptation of services to changing needs– longitudinality

Solution proposed:Integrated Service Delivery

(ISD) Network

PRISMA Parntership

• University researchers + health managers + health ministry

• From research questions, to grant funding, implementation testing, and knowledge translation

Comparison of two models of Integrated Care

Nested model(SIPA, PACE, CHOICE)

Embedded model(PRISMA)

HomeCare

Long-termCare Inst.

Hospital& Rehab.

Singleentry

Triage

Case-Manager

HomeCare

Hospital& Rehab.

Long-termCare Inst.

Case-ManagerMultidisciplinary

Team+/- Day Centre+/- Home care

Entry

ISD Network

1. Coordination between services

2. Single point of entry

3. Case-management

4. Individualized Service Plan

5. Unique assessment tool (SMAF), Case-mix classification system (Iso-SMAF Profiles) and PRISMA-7 case-finding tool

6. Information tool (Computerised Clinical Chart)

1. Co-ordination between services

• Strategic (decision makers)– Local Governance Table: structures, financing and protocols

• Hospitals and CSSSs CEOs

• Chairs and directors of voluntary or private agencies

– Shift of paradigm: client-centered population-centered

• Tactical (services’ managers)– Local Management Committee: mechanisms

• Operational (clinicians)– Multidisciplinary team

2. Single point of entry

• Common door to get access to all services

• Triage (for people not refered by prof.)– Case-finding instrument: PRISMA-7– reference to the right service or to the ISD

Network– link to the 24/7 nursing phone line

• Basic data collection (socio-demographic)

ISD Clientele (admission criteria)

• To be over 65

• To present moderate to severe disabilities– SMAF score 15 (out of 87)– Iso-SMAF profiles 4

• To show good potential for staying at home

• To need for 2 or more services (health and social)

3. Case-Manager• Functions

– basic assessment (functional autonomy, needs)– reference to other professionnals (for completing

the assessment)– planning of services (with patient & family)– service “broker”– patient advocacy– follow-up (periodic re-assessment)

3. Case-Manager

• Distributed by territory (neighbourhood)• Nurse or Social worker or others• Special training• Not associated with a single institution or agency but

with the Local Governance Table– intervenes wherever is the patient (“blue helmet”)

• May also provide direct care (in his/her field of competency)

• Case load: 40-45

Familyphysician

Single point of entry

Case-finding

Case Manager

Hospitals andRehab. services

Long-term careinstitutions

Voluntary Agencies

Social Economy Agencies

CSSS

Day Centre

Institutionnalization

(temp or permanent)

Geriatric services

Specialized and General Care ServicesRehabilitation

Home Care

Nursing Care

Occ. Therapy, etc.

Domestic tasks

Meals-on-wheels SpecializedPhysicians

4. Individualized Service Plan

• Prepared once the assessment is completed

• Lead by the Case-Manager

• Consensus amongst the providers

• Approval by patient (and/or family)– empowerment

• Includes the Management Plan of each provider

• Periodical revision

5. Unique assessment tool

1. SMAF: disability and handicap scale

2. Case-mix classification: Iso-SMAF Profiles– 14 different homogeneous patterns of disabilities

3. Case-finding tool: PRISMA-7

5. Unique assessment tool: 1. SMAF

• SMAF (Functional Autonomy Measurement System)Hébert et al, 1988; 2003

• 29-item scale developed according to the WHO classification of disabilities

• SISTEMA DE MEDIDA DA AUTONOMIA FUNCIONAL

• By Karla Cristina Giacomin and coll. (Profs. Drs. Maria Fernanda Lima-Costa, Elizabeth Uchôa, Josélia Firmo et Sérgio Peixoto, Dr Réjean Hébert)

• 29 Incapacidades– 5 domínios:

• 7 ADL: AVD• 8 IADL: AIVD• 6 Mobility: MOBILIDADE• 3 Communication: COMUNICAÇÃO• 5 Mental Function: FUNÇÕES COGNITIVAS

• Recursos– Materiais / sociais / arquiteturais– Estabilidade dos recursos Avalia 29 funções

• Handicap score

5. Unique assessment tool: 1. SMAF

• Melhor informação disponível • Escala de 5 graus, indo de 0 a -3:• 0 - faz sozinho/autônomo • - 0,5 - faz com dificuldade • -1 - necessita de supervisão ou estímulo • -2 - necessita de ajuda, mas participa• -3 - necessita de ajuda total/dependência

SMAF SISTEMA DE MEDIDA DA AUTONOMIA

FUNCIONAL

SMAF translated in Portuguese• Karla Cristina Giacomin• kcgiacomin@hotmail.com

• Excellent results (Coeficiente de correlação intra-classe)

• Thesis available at www.cpqrr.fiocruz.br• Epidemiologia da incapacidade funcional em idosos na comunidade:

Inquérito de Saúde de Belo Horizonte e tradução e confiabilidade do instrumento de avaliação funcional SMAF no Projeto Bambuí

Fundação Oswaldo CruzCentro de Pesquisas René RachouPrograma de Pós-graduação em Ciências da Saúde

Núcleo de Estudos em Saúde Pública e EnvelhecimentoCentro Colaborador da Secretaria de Vigilância em Saúde do Ministério da Saúde

5. Unique assessment tool : 2. Iso-SMAF Profiles

• Case-mix classification– Iso-SMAF Profiles

• 14 different homogeneous patterns of disabilities

• Generated from SMAF evaluation

• Functions:– Service allocation: admission criteria

– Monitoring

– Management: cost and resources by profile (budget equity)

PROFILS ISO-SMAF

PROBLEMS IN INSTRUMENTAL ACTIVITES OF DAILY LIVING ONLY

PREDOMINANT ALTERATIONSIN MOBILITY FUNCTIONS

HELP IN MOBILITY

BEDRIDDEN AND DEPENDENCY IN ADL

PREDOMINANT ALTERATIONSIN COGNITIVE FUNCTIONS

MIXED ALTERATIONSMOBILITY + COGNITIVE

Autonomous (0)Difficulties (0,5)Supervision (1)Help (2)Dependence (3)

Legend

DifficultiesADL MOB COM MF IADL

SupervisionADL MOB C OM MF IADL

HelpADL MOB COM MF IADL

Autonomous ADLADL MO B COM MF IADL

Difficulties ADL

Without incontinence

With incontinence(Majors behavioral problems)

ADL

ADL

MOB

MOB

COM

COM

M F

MF

IADL

IADL

Moderate + difficulties ADL

Severe + difficulties ADL

Severe + supervision mobility

Severe cognitive impaiment

Severe + help ADL(walke independently, behavioral problems)

Very severe cognitive impaiment(moderate behavioral problems)

ADL

ADL

ADL

ADL

A DL

ADL

MO B

MOB

MOB

MO B

MOB

MOB

COM

COM

COM

C OM

C OM

COM

M F

MF

MF

MF

MF

M F

IA DL

IA DL

IA DL

IADL

IA DL

IA DL

Help ADLADL

ADL

MO B

MO B

COM

C OM

M F

MF

IADL

IADL

49,09

59,0

12

23,04

20,0

13,52

9,0

1

32,0

6

59,0

11

52,0

10

43,0

8

74,0

14

65,5

13

39,0

7

29,0

5

Ó Centre de recher che en gérontologie et gériatrie

3

Iso-SMAF Profiles of Long-term Home Care clients

0% 20% 40% 60% 80% 100%

Direct Allocation(n=1 723)

Physical Deficiency(n=1 297)

Intel. Deficiency(n=439)

Disabled elderly (n=8 367)

Profil 1

Profil 2

Profil 3

Profil 4

Profil 6

Profil 9

Profil 5

Profil 7

Profil 8

Profil 10

Profil 11

Profil 12

Profil 13

Profil 14

Motor Dis.ADL Mental Dis. Very disabled

Distribution of ISO-SMAF profiles of a LTC facility

0% 20% 40% 60% 80% 100%

Carrefour santé du Granit (N=116)

CLSC-CH-CHSLD MRCAsbestos (N=96)

CLSC-CHSLD Haut-St-François (N=100)

Carrefour sss du Val-St-François

Carrefour sss CLSC-CHSLDMRC Coaticook (N=89)

CLSC- CHH Memphrémagog (N=130)

La Maison Blanche de NorthHatley Inc. (N=60)

Centre d'accueil Shermont Inc.(N=51)

Maison Reine-Marie Inc. (N=48)

CHSLD l'Estriade (N=379)

IUGS (N=386)

Région de l'Estrie (N=1590)

profil 1

profil 3

profil 4

profil 6

profil 9

profil 5

profil 7

profil 8

profil 10

profil 11

profil 12

profil 13

profil 14

MotorIADL Mental Mixed

5. Unique assessment tool : 3. PRISMA-7

• PRISMA-7 validated to identify older people with SMAF score ≥ 15

• Case-finding, not screening (related to future events)

• translated in Portuguese in Brazil: by Kylza Aquino Estrella et al.)

PRISMA-71. Você tem mais do que 85 anos de idade?2. Sexo Masculino?3. Em geral, você tem algum problema de saúde que

exija que você limite suas atividades?4. Você precisa de alguém para ajudá-lo

regularmente?5. Em geral, você tem algum problema de saúde que

exija que você fique em casa?6. Em caso de necessidade, você pode contar com

alguém próximo a você?7. Você regularmente usa muleta, andador ou cadeira

de rodas?

6. Information Tool

• Facilitates information flow

• Computerized Clinical Chart– accessible by all professionals and institutions– via internet (Quebec Health and Social services

Network)– security and privacy– data generator: for monitoring and research

The PRISMA Study :Implementation and Impact

Estrie project

• Funded by

• Implementation of the ISD Network within 3 areas– 1 urban : Sherbrooke– 2 rurals: Granit (Lac Mégantic) & Coaticook

• Evaluation– implementation (process): case-studies– impact (outcome): quasi-exp population design

Study territory

3 participating areas:

Urban: Sherbrooke 144,000 (18,500 >65)

Rurals: Coaticook (no hosp)16,500 (2,300 >65)

Lac-Mégantic (hosp)22,000 (3,300 >65)

Exp.

Eastern Townships pop. : 291 000 (40,000 >65)

Objectives for the implementation evaluation

Monitor the degree of implementation between sub-regions;

• Get the opinion of policy makers, managers, clinicians, client and caregivers about the implementation;

Assess the degree of integration; Analyse the work of the case-managers;• Analyse the trajectory of care of clients;• Evaluate the implementation of the CCC and the opinion

of users and clients about its utilization;• Analyse the ISP utilization; Identify the problems and difficulties in order to improve

the system.

Degree of implementationHébert et al. International J Integrated Care, 4, 2004

(www.ijic.org)

• Indicators developed for each of the 6 components– Focus group with partners and researchers

• Relative weighting of the components

• For each component– determination of the indicators– weighting of the indicators

• Data collection– minutes of meeting (collaboration)– observation (single-entry, case-manager, C CC)– chart review (tool, ISP)

Implentation Rate in Sherbrooke

0

20

40

60

80

100

%

07-200101-2002

07-200201-2003

07-200301-2004

07-2004

Dates

85,2%

Implementation Rate

0

20

40

60

80

100

%

SHERBROOKEGRANIT

COATICOOK 07-2001

01-2002

07-2002

01-2003

07-2003

01-2004

07-2004

Dates

85,2% 77,6% 69,3%

Conclusion for implementation

• PRISMA Model can be implemented• Implementation rates reached 70 to

85%• Perception of degree of integration by

managers and clinicians was good to very good (communication/cooperation level)

The PRISMA Impact Study

L’IsletL’Islet

LévisLévisMontmagnyMontmagny

GranitGranit

SherbrookSherbrookee

CoaticooCoaticookk

Experimental Zone

Comparison ZoneImpact

study

Summary Flow of the Study

2001 20022003 2004

T-1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

T-3T-2 T-42005

T-0

Implantation du RISPA

Total of 2 cohorts : 920 (2001) + 581 (2003) = 1501 (728-X, 773-T)

End: Mid-march

2006

T-2-B T-3-B T-4-B2003-4 2004-5 2005-6

Sherbrooke 205 171 149 118 97111 91 78

Coaticook 142 114 100 84 6758 53 43

Granit 154 135 112 92 7458 45 36

.

Lévis 176 139 123 88 75171 143 111

L’Islet 123 93 79 60 5597 88 82

Montmagny 120 95 80 65 5486 66 55

.

===== ==== ====== ===== =====

TOTAL: 920 747 643 507 422 +581 +486 +405

1224 993 827Ces données sont basées sur le nombre de sujets évalués à domicile

Functional Decline

0%

20%

40%

60%

80%

100%

X(n=465)

T(n=365)

2 first years

Loss of 5 points + SMAF

Death

Institutionnalised

0%

20%

40%

60%

80%

100%

X(n=541)

T (n=579)

2 last years

p=0,027

6.3% dif.

p=0.030

p=0.685

Evolution of subjects exposed to PRISMA(excluding death and institutionalized)

New Cases of Functional Decline(Incidence)

p < 0,001

0%

20%

40%

60%

80%

100%

X(n=244)

T (n=271)

Fourth Year

14% dif. p<0.001

0%

20%

40%

60%

80%

100%

X(n=412)

T(n=485)

Third Year

p=0,050

p=0.259

0%

20%

40%

60%

80%

100%

X(n=310)

T(n=237)

Second Year

p=0.316

0%

20%

40%

60%

80%

100%

X(n=474)

T(n=375)

First Year

p=0,057

p=0.568

Loss of 5 pts + on SMAF

Death

Institutionnalisation

0%

20%

40%

60%

80%

100%

X(n=588) T(n=636)

T2

0%

20%

40%

60%

80%

100%

X(n=483) T(n=509)

T3

Experimental

Comparison

0%

20%

40%

60%

80%

100%

X(n=419) T(n=327)

T1

p=0.026

0%

20%

40%

60%

80%

100%

X(n=394) T(n=433)

T4

p=0.054

p=0.203

p<0.001

Handicap (SMAF): Proportion with at least one unmet need

↓31%

Global Satisfaction

3,0

4,0

5,0

6,0

7,0

8,0

9,0

jan.2001

jan.2002

jan.2003

jan.2004

jan.2005

p<0,001

p=0,107

↑ of 5%

p<0,001

Impr

ovem

ent o

f sa

tisf

acti

on

p=0,003 p=0,026 p=0,226 p=0,925 p=0,106 p=0,002 p<0,001 p<0,001 p<0.001 p<0,001

X

C

Satisfaction with services

3,0

4,0

5,0

6,0

7,0

8,0

9,0

janv. 2001 janv. 2002 janv. 2003 janv. 2004 janv. 20053,0

4,0

5,0

6,0

7,0

8,0

9,0

janv.2001

janv.2002

janv.2003

janv.2004

janv.2005

Delivery Organization

p<0.001

p<0.001

X

C

Empowerment

3,0

3,5

4,0

4,5

5,0

5,5

6,0

6,5

7,0

jan. 2001 jan. 2002 jan. 2003 jan. 2004 jan. 2005

p<0,001

X

C

p<0,001

p<0,001

Impr

ovem

ent o

f E

mpo

wer

men

t

p=0,727 p=0,200 p=0,170 p=0,703 p=0,190 p=0,003 p=0,001 p<0,001 p=0,001 p=0,347

Services Utilization

• Emergency visits

• Hospitalizations• Home Services for older people (Day

Hospital & Centre, home care and services)

• Clinicians consultation (general practitioners, specialist, nurses and others)

• Voluntary services (meals-on-wheels, community meals, transportation, etc.)

At least one visit to ER

0,00

0,10

0,20

0,30

0,40

0,50

0,60

An 1 An 2 An 3 An 4

p< 0,001p=0,355

p<0,001

Pro

babi

lity

of a

t lea

st o

ne v

isit

p<0,001 p<0,001 p=0,149 p=0,232

X

C

At least one hospitalisation

0,00

0,05

0,10

0,15

0,20

0,25

0,30

0,35

0,40

An 1 An 2 An 3 An 4

p=0,113p=0,707

p=0,027

Pro

babi

lity

of b

eing

adm

itted

at l

east

onc

e

p=0,204 p=0,364 p=0,953 p=0.449

X

C

Other services

• No significant differences on:– Re-hospitalization– Consultations with health prof.– Utilization of home care services– Utilization of geriatric services

Total cost

0 $

4 000 $

8 000 $

12 000 $

16 000 $

20 000 $

24 000 $

Y 1 Y 2 Y 3 Y 4

X

C

p<0,001

p<0,001

Comparison:p=0,343

Public and private parts

* p<0,10

** p<0,05

*** p<0,01

Total Cost

0 $

2 000 $

4 000 $

6 000 $

8 000 $

10 000 $

12 000 $

14 000 $

An 1 An 2 An 3 An 4

Public part Private part

0 $

2 000 $

4 000 $

6 000 $

8 000 $

10 000 $

12 000 $

14 000 $

An 1 An 2 An 3 An 4

p<0,001

p<0,001

Comparison:p=0,541

p<0,001 p<0,001

Comparison:p=0,494

X

C

* p<0,10

** p<0,05

*** p<0,01

**

Conclusion for the impact

• Significant effect on:– Functional Decline: prevalence (6%) and Incidence (14%)– Handicap (Unmet needs): ↓ by half– Satisfaction and empowerment– ER– Hospitalisation (nearly significant)

• No effect on:– Institutionalization– Consultations with health prof– Home care services

• Equal Cost: improves the efficiency

Higher

Equal

Inferior

less

efficient

less

efficient

to evaluate

less

efficient

equally efficient moreefficient

notefficient

moreefficient

moreefficient

Lower Equal Higher

C

O

S

T

EFFECT

Efficiency Table Experimental zone compared to control zone

More efficient :

Decline

Handicaps

Satisfaction

Emporwerment

Equal efficiency:

Mortality

Autonomy Desire to institutionnalyse

Less efficient :

=COST

Lower Equal Higher

Efficiency results Experimental zone compared to control zone

EFFECT

Efficiency

• Cost equals → implementation and functioning cost of ISD : compensated by economy on services, without reducing efficacy

• ISD produced positive effects on autonomy, satisfaction, empowerment…

Final word

2005 ~ end of study: Merge

Hospital

Health and Social Services Centre

Home care (CLSC)

Long term care (Institution)++ ++

Globally

• But :Administrative integration ≠ clinical integration

• Integration do not solve everything:– Lack of home care services– Accessibility

• But now we know that it would be worst without integration !

Lessons learned and recommendations

• Working with older people: obligated to coordinate our actions with other intervening parties: – Functional decline is multifactorial;

multiple interventions from different sectors necessary vs health and autonomy problems

• Bring together the partners involved: a good step done today

Lessons learned and recommendations

• Consider time for coordination – most important

• Make agreement between partners, focus on what is good for older people

• Challenge: adapt the approach to local particularities – done in France

• Lack of coordination must now be considered as a risk factor for functional decline

Consult the web site at:www.usherbrooke.ca/prisma

Contact me:Michel.raiche@usherbrooke.ca

Obrigado pela atenção e pela acolhida

Research Team : Réjean Hébert, Michel Raîche Research : Danièle Blanchette, Suzanne Durand, Marie-France Dubois, Nicole Dubuc,

Michel Tousignant, Gina Bravo, Johanne Desrosiers, André Tourigny, Lucie Bonin, Pierre Durand, N’Deye Rokhaya Gueye, Anne Veil, Nathalie-Audrey Joly, Myriam Bergeron,

Maxime Gagnon, Marie-Claude Boissé, Valérie Guillot, Isabelle Labrecque, Dany Simard, Karine Veilleux, Annie Lévesque, Josée Mainville

Partners : Céline Bureau, Johanne Bolduc, Robert Bellefleur, Pierre Richard, Mariette Bédard, Linda Dieleman, Lysette Trahan et William Murray

Supplementary slides

Epidemiologia da incapacidade funcional em idosos na comunidade: Inquérito de Saúde de Belo Horizonte e

tradução e confiabilidade do instrumento de avaliação funcional SMAF no Projeto Bambuí

Núcleo de Estudos em Saúde Pública e EnvelhecimentoCentro Colaborador da Secretaria de Vigilância em Saúde do Ministério da Saúde

Karla C. Giacomin, MD, PhD

Orientadora: Profª MªFernanda Lima-Costa, MD, PhD

Co-orientadora: Profª Elizabeth Uchôa, MD, PhD

Fundação Oswaldo Cruz

Centro de Pesquisas René Rachou

Programa de Pós-graduação em Ciências da Saúde

Coeficiente de correlação intra-classe para avaliação dos dois observadores de acordo com a capacidade funcional avaliada

¹ Refere-se às dimensões das capacidades funcionais testadas.

Coeficiente de correlação intra-classe para avaliação do mesmo avaliador, em dois momentos diferentes, de acordo com a capacidade funcional avaliada

¹ Refere-se às dimensões das capacidades funcionais testadas.

29 Elementos do SMAF• AVD

– Alimentar-se– Lavar-se– Vestir-se– Cuidar de sua pessoa (escovar os dentes,

pentear-se, barba, unhas)

– Função vesical– Função intestinal– Utilizar o toalete

• Mobilidade– Transferências– Locomover-se no interior– Instalar prótese/órtese– Deslocar-se em cadeira de rodas– Uso de escadas– Locomover-se no exterior

• Comunicação– Visão– Audição– Fala

• Funções mentais– memória– orientação– compreensão– julgamento– comportamento

• AIVD– Cuidar da casa– Preparar as refeições– Fazer compras– Lavar as roupas– Utilizar o telefone– Utilizar os meios de transporte– Tomar seus remédios– Gerir seu dinheiro

PRISMA is funded by :

The Canadian Health Services Research Foundation

and the following agencies :. Five Regional Health and Social Services Authorities

(Estrie, Mauricie – Centre du Québec, Laval, Montérégie, Québec)

. Quebec Ministry of Health and Social Services

. Quebec Health Research Foundation (FRSQ)

. Quebec Research Network on Aging

. Sherbrooke Geriatric University Institute

Schedule of implementation

GranitCoaticook

Spring2001

Spring2002

Spring2003

Spring2004

Spring2005

Sherbrooke

Implementation

InterimReport

Formative ImplementationEvaluation

FinalReport

Summative ImplementationEvaluation

Integration measure

• Human Services Integration Measure Browne et al, International J Integrated Care, 4, 2004 (www.ijic.org)

– Depth of integration for each sector• 0= no awareness

• 1= awareness

• 2= communication (share information)

• 3= coordination or cooperation (modify to avoid duplication)

• 4= collaboration (jointly plan services)

– Completed following focus groups by representatives of each sector involved

Mean Depth of Integration

Unawareness

Cooperation

Communication

Awareness

Collaboration

4

3

2

1

0

Coaticook: 2.4

►

Granit: 2.3

▼

Perfect

Excellent

Very good

Good

Moderate

Mild

Little

Very little

Browne’s

Indicators

Sherbrooke: 2.5

▲

Perceived integration

0%10%20%30%40%50%

60%70%80%90%

100%

Sherbrooke Granit Coaticook

Per

ceiv

ed in

tegr

atio

n

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