A novel model of integrated care for the elderly: COPA, Coordination of Professional Care for the Elderly
Isabelle Vedel1,2, Matthieu De Stampa1,2, Howard Bergman2,3, Joel Ankri1, Bernard Cassou1, Claire Mauriat1, François Blanchard4, Emmanuel Bagaragaza1 and Liette Lapointe2,5
1Université de Versailles St-Quentin, Laboratoire «Santé Vieillissement», AP-HP, Hôpital Sainte Perine, Paris, France, 2Solidage, McGill University - Université de Montréal Research Group on Frailty and Aging, Montreal, Quebec, Canada, 3Division of Geriatric Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada, 4Université de Reims Champagne Ardennes, Laboratoire «Santé Publique, Vieillissement et troubles cognitifs et du comportement», Hôpital Sébastopol, Reims, France, 5Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada

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. (Aging Clin Exp Res 2009; 21: 414-423) ©2009, Editrice Kurtis

[« Back] [Not subscriber] [Subscriber] [Order printable]