Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership

Stampa, Matthieu de; Vedel, Isabelle; Mauriat, Claire; Bagaragaza, Emmanuel; Routelous, Christelle; Bergman, Howard; Lapointe, Liette; Cassou, Bernard; Ankri, Joël; Henrard, Jean-Claude

doi:10.5334/ijic.506

Cited by 22 publications

(30 citation statements)

References 20 publications

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“…interRAI France is driven by a mixed team of clinicians and non-clinicians, who provide a strong support to promote the instruments and engage with a larger number of stakeholders. It has been shown that this double leadership is a strong incentive for supporting the case management, reinforcing the inter-professional bonds and changing professional practices [48]. …”

Section: Discussionmentioning

confidence: 99%

Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments

Stampa

Cerase²,

Bagaragaza

et al. 2018

International Journal of Integrated Care

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Background:The improvement of quality of care requires a standardized and comprehensive assessment tool but implementation is challenging.Purpose:We have reported on the development of the interRAI instruments in France from the onset to the mandatory use at the national level. We also have identified in the literature and in practices, incentives and barriers for the implementation of this integrated clinical information system in long term care.Results:Three periods in the interRAI instruments development were identified over the last twenty years. The first one was a research approach about improving quality of long term care. The second one was an experimental clinical use into an integrated care model with case management. The third one was a call for tenders issued by a French national agency, and the choice to use the interRAI-HC (Home Care) for all case managers. The main incentives and barriers that were identified include the national context, the target population, the providers involved and the impact on their practice, the interRAI instrument characteristics, training and leadership.Conclusion:This historical overview of the development of interRAI instruments in France gives health care organizations pertinent information to guide the implementation of a standardized and comprehensive assessment tool.

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Section: Discussionmentioning

confidence: 99%

Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments

Stampa

Cerase²,

Bagaragaza

et al. 2018

International Journal of Integrated Care

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“…While an increasing number of papers on integrated care focus primarily on leadership, the majority are theoretical or discussion papers [484950] with few empirical studies [51]. …”

Section: Discussionmentioning

confidence: 99%

Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

Evans¹,

Grudniewicz²,

Baker³

et al. 2016

Int J Integr Care

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Background:Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability.Purpose:This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts.Methods:The Context and Capabilities for Integrating Care (CCIC) Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks in Ontario, Canada. Interviews involved open-ended questions and graphic elicitation. Quantitative content analysis was used to summarize the data.Results:The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to implement integrated care interventions include Leadership Approach, Clinician Engagement and Leadership, and Readiness for Change. The majority of hypothesized relationships among organizational capabilities involved Readiness for Change and Partnering, emphasizing the complexity, interrelatedness and importance of these two factors to integrated care efforts.Conclusions:Organizational leaders can use the framework to determine readiness to integrate care, develop targeted change management strategies, and select appropriate partners with overlapping or complementary profiles on key capabilities. Researchers may use the results to test and refine the proposed framework, with a focus on the hypothesized relationships among organizational capabilities and between organizational capabilities and performance outcomes.

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“…We assumed that by realizing a bottom-up approach [20] physicians` adherence to the recommendations of the treatment pathway would be enhanced. By doing so it was intended to coordinate prescription of drugs and scheduling regular visits with the GP and the cardiologist.…”

Section: Methodsmentioning

confidence: 99%

Associations between demographic, disease related, and treatment pathway related variables and health related quality of life in primary care patients with coronary heart disease

Kramer

Hirsch

Schlöβler

et al. 2012

Health and Quality of Life Outcomes

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BackgroundCoronory heart disease (CHD) is a common medical problem worldwide that demands shared care of general practitioners and cardiologists for concerned patients. In order to improve the cooperation between both medical specialists and to optimize evidence-based care, a treatment pathway for patients with CHD was developed and evaluated in a feasibility study according to the recommendation for the development and evaluation of complex interventions of the British Medical Research Council (MRC). In the context of this feasibility study the objective of the present research was to investigate the contributions of different disease related (e.g. prior myocardial infarction), pathway related (e.g. basic medication) and demographic variables on patients` perceived health related quality of life (HRQoL) as a relevant and widely used outcome measure in cardiac populations.MethodsData assessing demographic, disease and pathway related variables of CHD patients included in the study were collected in a quasi-experimental design with three study arms (pathway developers, users, control group) via case record forms and questionnaires at baseline and after 6 and 12 (intervention groups), and 9 months (control group), respectively after the initial implementation on GP level. Additionally, at the same measuring points the CHD patients participating in the study were interviewed by phone regarding their perceived HRQoL, measured with the EuroQol EQ-5D as an index-based health questionnaire. Due to the hierarchical structure of the data, we performed cross-sectional and longitudinal linear mixed models to investigate the impact of disease related, pathway related and demographic variables on patients` perceived HRQoL.ResultsOf 334 initially recruited patients with CHD, a total of 290 were included in our analysis. This was an average 13.2% dropout rate from baseline assessment to the 12-month follow-up. At all assessment points, patients` HRQoL was associated with a variety of sociodemographic variables (e.g. gender, employment, education) in each study group, but there was no association with pathway related variables. In both cross-sectional and longitudinal analyses highest HRQoL values in patients were reported in the physician group that had developed the pathway. In the longitudinal analyses there were no significant changes in the reported HRQoL values of the three groups over time.ConclusionsThe found associations between sociodemographic variables and the perceived HRQoL of patients with CHD are in line with other research. As there are no associations of HRQoL with pathway related variables like the basic medication, possible weaknesses in the study design or the choice of outcome have to be considered before planning and conducting an evaluation study according to the MRC recommendations. Additionally, as patients in the developer group reported the highest HRQoL values over time, a higher commitment of the GPs in the developer group can be assumed and should be considered in further research.

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Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership

Abstract: Background: Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs).

Cited by 22 publications

References 20 publications

Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments

Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments

Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

Associations between demographic, disease related, and treatment pathway related variables and health related quality of life in primary care patients with coronary heart disease

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