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Canada: Application of a Coordinated-Type Integration Model for Vulnerable Older People in Québec: The PRISMA Project

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Handbook Integrated Care

Abstract

Several models of Integrated Service Delivery (ISD) networks were experimented and tested, but most of them are designed according to a full integration model. PRISMA is the only example of a coordinated-type model to be developed and fully implemented with a process and outcome evaluation. The PRISMA model includes the following components to enhance the integration: (1) co-operation between decision-makers and managers of all services and organizations, (2) the use of a single entry point with a case-finding instrument (PRISMA-7), (3) a case management process, (4) Individualized Service Plans, (5) a unique disability-based assessment tool (SMAF) with a case-mix system (Iso-SMAF profiles), and (6) a computerized system for communicating between institutions and professionals.

The PRISMA model was experimentally implemented in three areas (urban, rural with or without a local hospital) in Quebec, Canada and research was carried out using both qualitative and quantitative data to evaluate its process and impact. The impact study was population-based with a quasi-experimental design. The experimental group presented a difference of 6.3% on functional decline prevalence (p = 0.03). The incidence of new cases of functional decline was also significantly lower by 1.4%. Satisfaction and empowerment were significantly higher (both p < 0.001) in the experimental group. For health services utilization, a 20% reduction of visits to emergency room (p < 0.001) was observed in the experimental cohort. The hospitalization rate was also lower in the experimental group but the difference was not statistically significant (p = 0.19). No significant effect was observed on other services. Their overall cost was not higher in the experimental group, even when implementation cost was included. The study demonstrated that the PRISMA model improves the health of frail older people and the effectiveness of the health care system without additional cost.

The model was gradually implemented in the Province of Quebec from 2005 to 2015. The implementation was slowed down by a big reform in 2003–2007 that merged public hospitals, nursing homes and primary care agencies into Health and Social Services Centres (HSSC) serving local communities. That structural integration was detrimental to the functional integration process associated with the implementation of the PRISMA model. More recently a new major structural reform with merging of local HSSC into regional large institutions threatens the institutionalization of the integrated model.

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Notes

  1. 1.

    All the publications on the PRISMA model and experiments, in both French and English are available on the following website: http://www.prisma-qc.ca/cgi-cs/cs.waframe.index?lang=2

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Authors and Affiliations

  1. Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada

    Réjean Hébert

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  1. Réjean Hébert
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Correspondence to Réjean Hébert .

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Editors and Affiliations

  1. Institute for Epidemiology, Social Medicine and Health System Research, Medical School Hannover, Hannover, Germany

    Volker Amelung

  2. International Foundation for Integrated Care, Oxford, United Kingdom

    Viktoria Stein

  3. International Foundation for Integrated Care, Oxford, United Kingdom

    Nicholas Goodwin

  4. Health Policy Research and Planning, Clalit Health Services, Tel-Aviv, Israel

    Ran Balicer

  5. European Observatory on Health Systems and Policies, London School of Economics and Political Science, London School of Hygiene & Tropical Medicine, London, United Kingdom

    Ellen Nolte

  6. Workforce Research & Evaluation, Alberta Health Services Calgary, Calgary, Alberta, Canada

    Esther Suter

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Hébert, R. (2017). Canada: Application of a Coordinated-Type Integration Model for Vulnerable Older People in Québec: The PRISMA Project. In: Amelung, V., Stein, V., Goodwin, N., Balicer, R., Nolte, E., Suter, E. (eds) Handbook Integrated Care. Springer, Cham. https://doi.org/10.1007/978-3-319-56103-5_30

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