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

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.

Factors associated with the utilization and costs of health and social services in frail elderly patients

“…This is consistent with the literature emphasizing the significance of integrated care for the elderly [33-35]. Still, when need factors were controlled for, municipalities with integrated health and social care sectors had similar patterns in access to care and similar costs as compared to municipalities without such integration.…”

Ten years of integrated care for the older in France

“…In recent years, the French system has studied the potential of case management, often taking disease management as a starting point, as reflected in a report by the General Inspectorate of Social Affairs [20]. Some recent experiments in France at the local level [21] or at multiple sites [22] have tested the integration paradigm. The preliminary results have been promising, prompting decision makers to consider implementing this organizational model at a larger scale.…”

Depression in the Context of Chronic and Multiple Chronic Illnesses

“…Multidisciplinary approaches have been trialled and discussed in a range of health care settings, including maternity and child health services (Schmied, Mills et al 2010), chronic headache care (Gaul, Bromstrup et al 2011), community-dwelling elders (Vedel, De Stampa et al 2009), eczema sufferers (van Gils, van der Valk et al 2009) and has been found to optimise patient outcomes in palliative care for lung cancer (Borneman, Koczywas et al 2008) and short bowel syndrome (Modi, Langer et al 2008). The dynamics of multidisciplinary teams have been studied in post-cancer follow-up care (Leib, Cieza et al 2011) and maternity care (McIntyre, Francis et al 2011), as well as in a hospital setting (Hogan, Barry et al 2011).…”