Aging Clinical and Experimental Research

, Volume 21, Issue 6, pp 414–423

A novel model of integrated care for the elderly: COPA, Coordination of Professional Care for the Elderly

  • Isabelle Vedel
  • Matthieu De Stampa
  • Howard Bergman
  • Joel Ankri
  • Bernard Cassou
  • Claire Mauriat
  • François Blanchard
  • Emmanuel Bagaragaza
  • Liette Lapointe
Special Article

Abstract

Despite strong evidence for the efficacy of integrated systems, securing the participation of health professionals, particularly primary care physicians (PCPs), has proven difficult. Novel approaches are needed to resolve these problems. We developed a model — COPA — that is based on scientific evidence and an original design process in which health professionals, including PCPs, and managers participated actively. COPA targets very frail community-dwelling elders recruited through their PCP. It was designed to provide a better fit between the services provided and the needs of the elderly in order to reduce excess healthcare use, including unnecessary emergency room (ER) visits and hospitalizations, and prevent inappropriate long-term nursing home placements. The model’s originality lies in: 1) having reinforced the role played by the PCP, which includes patient recruitment and care plan development; 2) having integrated health professionals into a multidisciplinary primary care team that includes case managers who collaborate closely with the PCP to perform a geriatric assessment (InterRAI MDS-HC) and implement care management programs; and 3) having integrated primary medical care and specialized care by introducing geriatricians into the community to see patients in their homes and organize direct hospitalizations while maintaining the PCP responsibility for medical decisions. Since COPA is currently the subject of both a quasi-experimental study and a qualitative study, we are also providing preliminary findings. These findings suggest that the model is feasible and well accepted by PCPs and patients. Moreover, our results indicate that the level of service utilization in COPA was less than what is reported at the national level, without any compromises in quality of care.

Keywords

care management elderly integrated care organizational 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mion L, Odegard PS, Resnick B et al. Interdisciplinary care for older adults with complex needs: American Geriatrics Society position statement. J Am Geriatr Soc 2006; 54: 849–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Reuben DB. Organizational interventions to improve health outcomes of older persons. Med Care 2002; 40: 416–28.PubMedCrossRefGoogle Scholar
  3. 3.
    Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 2002; 162: 2269–76.PubMedCrossRefGoogle Scholar
  4. 4.
    Wieland D, Lamb VL, Sutton SR et al. Hospitalization in the Program of All-inclusive Care for the Elderly (PACE): rates, concomitants, and predictors. J Am Geriatr Soc 2000; 48: 1373–80.PubMedGoogle Scholar
  5. 5.
    Beland F, Bergman H, Lebel P et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Bid Sci Med Sci 2006; 61: 367–73.CrossRefGoogle Scholar
  6. 6.
    Landi F, Onder G, Russo A et al. A new model of integrated home care for the elderly: impact on hospital use. J Clin Epidemiol 2001; 54: 968–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Landi F, Lattanzio F, Gambassi G et al. A model for integrated home care of frail older patients: The Silver Network project. Aging Clin Exp Res 1999; 11: 262–72.Google Scholar
  8. 8.
    Challis D, Darton R, Johnson L et al. An evaluation of an alternative to long-stay hospital care for frail elderly patients: II. Costs and effectiveness. Age Ageing 1991; 20: 245–54.CrossRefGoogle Scholar
  9. 9.
    Johri M, Beland F, Bergman H. International experiments in integrated care for the elderly: a synthesis of the evidence. Int J Geriatr Psychiatry 2003; 18: 222–35.PubMedCrossRefGoogle Scholar
  10. 10.
    Kane RL, Homyak P, Bershadsky B. Consumer reactions to the Wisconsin Partnership Program and its parent, the Program for All-inclusive Care of the Elderly (PACE). Gerontologist 2002; 42: 314–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Kane RL, Homyak P, Bershadsky B, Lum YS. Consumer responses to the Wisconsin Partnership Program for Elderly Persons: a variation on the PACE Model. J Gerontol A Biol Sci Med Sci 2002; 57: 250–8.CrossRefGoogle Scholar
  12. 12.
    Newcomer R, Harrington C, Kane R. Implementing the second generation social health maintenance organization. J Am Geriatr Soc 2000; 48: 829–34.PubMedGoogle Scholar
  13. 13.
    Newcomer R, Harrington C, Kane R. Challenges and accomplishments of the second-generation social health maintenance organization. Gerontologist 2002; 42: 843–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Eccles M, Grimshaw J, Walker A et al. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol 2005; 58: 107–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Berwick DM. Disseminating innovations in health care. JAMA 2003; 289: 1969–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Hirdes JP. Addressing the health needs of frail elderly people: Ontario’s experience with an integrated health information system. Age Ageing 2006; 35: 329–31.PubMedCrossRefGoogle Scholar
  18. 18.
    Carpenter GI. Accuracy, validity and reliability in assessment and in evaluation of services for older people: the role of the interRAI MDS assessment system. Age Ageing 2006; 35: 327–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Landi F, Tua E, Onder G et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care 2000; 38: 1184–90.PubMedCrossRefGoogle Scholar
  20. 20.
    Bernabei R, Landi F, Onder G, Liperoti R, Gambassi G. Second and third generation assessment instruments: the birth of standardization in geriatric care. J Gerontol A Biol Sci Med Sci 2008; 63: 308–13.PubMedCrossRefGoogle Scholar
  21. 21.
    Counsell SR, Callahan CM, Clark DO et al. Geriatric care management for low-income seniors: a randomized controlled trial. JAMA 2007; 298: 2623–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Tourigny A, Durand P, Bonin L et al. Quasi-experimental study of the effectiveness of an integrated service delivery network for the frail elderly. Can J Aging 2004; 23: 231–46.PubMedCrossRefGoogle Scholar
  23. 23.
    Elkan R, Kendrick D, Dewey M et al. Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ 2001; 323: 719–25.PubMedCrossRefGoogle Scholar
  24. 24.
    Wolff JL, Boult C. Moving beyond round pegs and square holes: restructuring Medicare to improve chronic care. Ann Intern Med 2005; 143: 439–45.PubMedCrossRefGoogle Scholar
  25. 25.
    Kodner DL. The quest for integrated systems of care for frail older persons. Aging Clin Exp Res 2002; 14: 307–13.PubMedCrossRefGoogle Scholar
  26. 26.
    Shannon GR, Wilber KH, Allen D. Reductions in costly healthcare service utilization: findings from the Care Advocate Program. J Am Geriatr Soc 2006; 54: 1102–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Phelan EA, Balderson B, Levine M et al. Delivering effective primary care to older adults: a randomized, controlled trial of the senior resource team at group health cooperative. J Am Geriatr Soc 2007; 55: 1748–56.PubMedCrossRefGoogle Scholar
  28. 28.
    Mouquet MC. Les motifs de recours à l’hospitalisation de court séjour en 2003. Études et Résultats 2005; 444: 1–8.Google Scholar
  29. 29.
    Carrasco V, Baubeau D. Les usagers des urgences: Premiers résultats d’une enquête nationale. Etudes et Résultats 2003; 212: 1–8.Google Scholar
  30. 30.
    INSEE 2006 (online). Available at www.insee.fr/fr/ffc/chifcle_fiche.asp?tab_id=108 Accessed March 11, 2008.
  31. 31.
    Warshaw GA, Bragg EJ, Shaull RW et al. Geriatric medicine fellowship programs: a national study from the Association of Directors of Geriatric Academic Programs’ Longitudinal Study of Training and Practice in Geriatric Medicine. J Am Geriatr Soc 2003; 51: 1023–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Wagner EH. Chronic disease care. BMJ 2004; 328: 177–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Stille CJ, Jerant A, Bell D et al. Coordinating care across diseases, settings, and clinicians: a key role for the generalist in practice. Ann Intern Med 2005; 142: 700–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Wenger NS, Solomon DH, Roth CP et al. The quality of medical care provided to vulnerable community-dwelling older patients. Ann Intern Med 2003; 139: 740–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Bos JT, Frijters DH, Wagner C et al. Variations in quality of Home Care between sites across Europe, as measured by Home Care Quality Indicators. Aging Clin Exp Res 2007; 19: 323–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Stuck AE, Egger M, Hammer A et al. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 2002; 287: 1022–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Schraeder C, Shelton P, Sager M. The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2001; 56A: M106–12.CrossRefGoogle Scholar
  38. 38.
    Singh D, Ham C. Transforming Chronic Care: evidence about improving care for people with long-term conditions. HSMC 2005, University of Birmingham (online). Available at www.hsmc.bham.ac.uk/news/TransformingChronicCare.pdf Accessed March 11, 2008.
  39. 39.
    Fenina A, Geffroy Y. Les comptes nationaux de la santé en 2005. Etude et Résultats 2006; 505.Google Scholar
  40. 40.
    Algava E, Plane M. Vieillissement et protection sociale: une projection comparée pour 6 pays de l’Union européenne. Etude et Résultats 2001; 134.Google Scholar
  41. 41.
    Henrard JC. Vieillissement et santé. Le système français d’aide et de soins aux personnes âgées. Santé Société et Solidarité: Revue de l’Observatoire Franco-Quebecois de la Santé et de la Solidarité 2002; 2: 73–82.Google Scholar
  42. 42.
    Frossard M, Genin N, Guisset MJ, Villez A. Providing integrated health and social care for older persons in France — an old idea with a great future. In Leichsenring K, Alaszewski AM, eds. Providing integrated health and social care for older persons. Aldershot: Ashgate, 2004: pp. 229–68.Google Scholar
  43. 43.
    Com-Ruelle LP, Dourgnon P. Can physician gate-keeping and patient choice be reconciled in France? Analysis of recent reform. Eurohealth 2006; 12: 17–20.Google Scholar
  44. 44.
    Anderson GF, Hussey PS. Population aging: a comparison among industrialized countries. Health Aff (Millwood) 2000; 19: 191–203.CrossRefGoogle Scholar
  45. 45.
    Colin C, Coutton V. Le nombre de personnes âgées dépendantes d’après l’enquête handicaps-incapacités-dépendance. Etudes et résultats 2000; 94.Google Scholar
  46. 46.
    Bressé S. Les bénéficiaires des services d’aide et de soins aux personnes à domicile en 2000. Etude et Résultats 2004; 296.Google Scholar
  47. 47.
    Carpenter I, Gambassi G, Topinkova E et al. Community care in Europe. The Aged in Home Care project (AdHOC). Aging Clin Exp Res 2004; 16: 259–69.PubMedCrossRefGoogle Scholar
  48. 48.
    Dutheil N. Les aides et les aidants des personnes âgées. Etudes et Résultats 2001; 142.Google Scholar
  49. 49.
    Derame G, El Kouri D. Les passages non justifiés au service d’accueil urgences: Proposition d’une offre de soins différenciée. La Presse Médicale 2004; 33: 780–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2009

Authors and Affiliations

  • Isabelle Vedel
    • 1
    • 2
  • Matthieu De Stampa
    • 1
    • 2
  • Howard Bergman
    • 2
    • 3
  • Joel Ankri
    • 1
  • Bernard Cassou
    • 1
  • Claire Mauriat
    • 1
  • François Blanchard
    • 4
  • Emmanuel Bagaragaza
    • 1
  • Liette Lapointe
    • 2
    • 5
  1. 1.Laboratoire «Santé Vieillissement», AP-HP, Hôpital Sainte PerineUniversité de Versailles St-QuentinParisFrance
  2. 2.SolidageMcGill University — Université de Montréal Research Group on Frailty and AgingMontrealCanada
  3. 3.Division of Geriatric MedicineMcGill University, Jewish General HospitalMontrealCanada
  4. 4.Laboratoire «Santé Publique, Vieillissement et troubles cognitifs et du comportement», Hôpital SébastopolUniversité de Reims Champagne ArdennesReimsFrance
  5. 5.Desautels Faculty of ManagementMcGill UniversityMontrealCanada
  6. 6.Laboratoire “Santé Vieillissement”University of Versailles Saint-Quentin, AP-HPParisFrance

Personalised recommendations