Care for Canada's frail elderly population: fragmentation or integration? (original) (raw)
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International Journal of Integrated Care
The aim of this paper is to set the foundation for subsequent empirical studies of the "Implementing models of primary care for older adults with complex needs" project, by introducing and presenting a brief descriptive comparison of the nine case studies in Quebec, Ontario and New Zealand. Each case is described based on key dimensions of Rainbow model of Valentijn and al (2013) with a focus on "meso level" integration. Meso level integration is represented by organizational and professional elements of the Rainbow Model, which are of particular interest in our nine case studies. Each of the three cases in Ontario and three in New Zealand are different and described separately. In Quebec, a local health services network model is presented across the three cases studied with variations in the way it is implemented. The three cases selected in the three jurisdictions under study were not chosen to be representative of wider practice within each country, but rather represent interesting and unique models of communitybased primary healthcare integration. Similarities and variations in the integrated care models, context and dimension of integration offer insights regarding core component of integration of services, offering a foundational understanding of the cases on which future analysis will be based.
Addressing health care needs for frail seniors in Canada: the role of interRAI instrument
uch has been stated about the aging of the Canadian population and the resulting impact on health care spending. In 2011, persons aged 65 years and over accounted for 14.1% of the Canadian population, a proportion expected to approach 25% by 2036. 1 However, recent evidence confirms that rising health care spending results less from aging per se, but rather from the growing burden of chronic diseases among seniors. 2 At least three quarters of Canadians over the age of 65 years report having at least one chronic condition, and over 40% have three or more chronic conditions. 2,3 Multimorbidity (the coexistence of multiple chronic diseases) in seniors has been associated with greater health care utilization and poorer health status. Management of chronic disease in Canada remains suboptimal due, at least in part, to uncoordinated and fragmented service delivery. 4-6 Comprehensive assessment tools such
Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada
International journal of integrated care, 2011
Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery. Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases. Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in ...
Editorial: Policy Issues in Care for the Elderly in Canada
Canadian Journal on Aging / La Revue canadienne du vieillissement, 1995
This special issue of the Canadian Journal on Aging focuses on the current discussions about the future financing of health care and social services in Canada. These discussions are of particular relevance to Canadian elders both because the growth in their numbers is often perceived as one of the contributors to the need for change and because they have a major stake in the outcome. It is, therefore, important to examine whether the current financial, economic, demographic and technological pressures have radically modified the parameters defining the financing, planning and management of health care. Can the current terms of health insurance be maintained? Quebec, for example, set up a parliamentary subcommittee in 1991 to examine a radical reform of the financing of medical services on the assumption that the debt crisis necessitated drastic action. This debate elicited proposals for solutions such as the imposition of user fees, de-insurance and privatization. The proponents of these solutions claimed that these remedies would not only address fiscal constraints but would improve the functioning of the system over the long haul. The contribution of Robert Evans, Morris Barer and Greg Stoddart in this issue demonstrates, however, that such solutions would result in weakening the capacity of provincial, regional and local governments and organizations to control the cost of health services and to make appropriate health care decisions. These types of responses to our current problems, would, if implemented, have the paradoxical consequences of increasing the cost of medical services and aggravating the problem. Though the debate on user fees and de-insurance seems to have faded away, the 1995 federal budget with current and built-in future reductions in federal transfer payments to the provinces for health care, education and social services will likely revive the debate. Nevertheless, the focus of the debate on social programs may well now shift from Medicare to old age pensions, while long-term care remains on the agenda. That is why, in this issue of the Journal, these three aspects of social policy for the elderly are addressed in ten papers by Canadian authors and in three comments from observers from three countries: France, the United States and Great Britain. The rhetoric on the financing of medical services ignores an important historical reality. Since the beginning of universal health insurance, the provinces have developed mechanisms which have, until now, shown a capacity to adapt to the new conditions now confronting the health care systems of all western countries. The recent debates have never demonstrated that
Integrated Services for Frail Elders (SIPA): A Trial of a Model for Canada
Canadian Journal on Aging-revue Canadienne Du Vieillissement, 2006
Le complexe formé par les maladies chroniques, les épisodes de maladies aiguës, les déficiences physiologiques, les incapacités fonctionnelles et les problèmes cognitifs dominent les personnes âgées fragiles. Elles comptent sur l'aide des programmes sociaux et de santé qui, au Canada, sont encore fragmentés. Le SIPA (Services intégrés pour les personnes âgées fragiles) est un modèle de services intégrés basé sur des services de proximité, une équipe multidisciplinaire et un gestionnaire de cas qui détiennent la responsabilité clinique de l'ensemble des services sociaux et de santé requis, la capacité de mobiliser des ressources en fonction des besoins et l'application de protocole de soins. Le projet de démonstration SIPA a utilisé un devis expérimental avec assignation aléatoire de 1 230 participants, de deux quartiers de Montréal, dans un groupe expérimental et un groupe témoin. Les coû ts des services institutionnels ont été de 4 270 $ inférieur dans le SIPA comparés au groupe témoin, les coû ts des services de proximité ont été supérieurs de 3 394 .Laproportiondespersonnesenattented′heˊbergementenho^pitauxdecourtedureˊeaeˊteˊdeuxfoispluseˊleveˊedanslegroupeteˊmoinquedanslegroupeSIPA.Lescou^tsdeshospitalisationsdecourtedureˊedespersonnesduSIPAavecincapaciteˊdanslesactiviteˊsdelaviequotidienneonteˊteˊinfeˊrieursd′aumoins4000. La proportion des personnes en attente d'hébergement en hô pitaux de courte durée a été deux fois plus élevée dans le groupe témoin que dans le groupe SIPA. Les coû ts des hospitalisations de courte durée des personnes du SIPA avec incapacité dans les activités de la vie quotidienne ont été inférieurs d'au moins 4 000 .Laproportiondespersonnesenattented′heˊbergementenho^pitauxdecourtedureˊeaeˊteˊdeuxfoispluseˊleveˊedanslegroupeteˊmoinquedanslegroupeSIPA.Lescou^tsdeshospitalisationsdecourtedureˊedespersonnesduSIPAavecincapaciteˊdanslesactiviteˊsdelaviequotidienneonteˊteˊinfeˊrieursd′aumoins4000 à ceux des personnes du groupe témoin. En conclusion, l'expérimentation SIPA démontre qu'il est possible de s'engager dans des projets de démonstration ambitieux et rigoureux au Canada. Ces résultats ont été obtenus sans augmentation des coû ts globaux des services sociaux et de santé, sans diminution de la qualité des soins et sans augmentation du fardeau des personnes âgées et de leurs proches.
BMJ Open
Introduction Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circ...
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2009
I NTEGRATED service delivery (ISD) systems have been proposed for improving effi cacy and effi ciency of health care systems, particularly for patients with multiple needs and complex interactions with many professionals and organizations. The hypothesis is that ISD systems would improve continuity of care, health, and satisfaction of patients, while decreasing the use of costly resources, like hospitals and institutions. Although there are some indications of the effi cacy of ISD systems for some groups, such as frail older people (Johri, Béland, & Bergman, 2003), their real effectiveness at the population level remains to be demonstrated. According to W. N. Leutz (1999) , there are three types of integration in health care: (a) linkage, (b) coordination, and (c) full integration. In fully integrated ISD systems, the integrated organization is responsible for all services, either under one structure (Day Center or Home Care Services) or by contracting some services from other organizations. There have been many attempts to design and implement full integration models: the California On Lok project (Yordi & Waldman, 1985) that gave rise to the Program of All Inclusive Care for the Elderly projects in the United States (Branch, Coulam, & Zimmerman, 1995), the Darlington project in United Kingdom (Challis, Darton, Johnson, Stone, & Traske, 1991), the Social Health Maintenance Organization (S-HMO) in the USA (Leutz et al., 1985), and the SIPA (French acronym for System of Integrated Care for Older Persons, Béland et al., 2006) project in Canada. The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) model is a different model of coordination-based integrated care (Hébert et al., 2003). As opposed to fully integrated systems, this model uses all the public, private, or voluntary health and social service organizations involved in caring for older people in a given area. Every organization keeps its own structure but agrees to participate under an umbrella system and to adapt its operations and resources to the agreed requirements and processes. At this level, the ISD system is not just nested in the health care and social services system (like the full integration models): it is embedded within it. The study's objective was to measure the impact of the PRISMA model on the health, satisfaction, and empowerment of frail older people, their use of services, and the burden on their principal informal caregiver. The study was carried out in the Province of Québec in Canada.
Journal of Integrated …, 2008
PRISMA is the only example of a co-ordinatedtype model to be developed and fully implemented with a process and outcome evaluation. The PRISMA model was implemented in three areas (urban, rural with or without a local hospital) in Quebec, Canada and an implementation evaluation was carried out using mixed (qualitative and quantitative) methods. Over four years, the implementation rates went from 22% to 79%. The perception of integration by managers and clinicians working in the various organisations of the network shows that most interactions are perceived as at the co-operation level, some getting the highest collaboration level. The perception of the efficacy of case managers was very high. Implementing such a model is feasible, and the decision to generalise it was made in Quebec. This model might be more appropriate for a universal publicly funded health care system like those in Canada, the UK and the Scandinavian countries.