A novel model of integrated care for the elderly: COPA, Coordination of Professional Care for the Elderly
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.
Keywordscare management elderly integrated care organizational
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- 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
- 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.Carrasco V, Baubeau D. Les usagers des urgences: Premiers résultats d’une enquête nationale. Etudes et Résultats 2003; 212: 1–8.Google Scholar
- 30.INSEE 2006 (online). Available at www.insee.fr/fr/ffc/chifcle_fiche.asp?tab_id=108 Accessed March 11, 2008.
- 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.Fenina A, Geffroy Y. Les comptes nationaux de la santé en 2005. Etude et Résultats 2006; 505.Google Scholar
- 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.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.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.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
- 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.Bressé S. Les bénéficiaires des services d’aide et de soins aux personnes à domicile en 2000. Etude et Résultats 2004; 296.Google Scholar
- 48.Dutheil N. Les aides et les aidants des personnes âgées. Etudes et Résultats 2001; 142.Google Scholar