Application of a coordinated-type integration model for vulnerable older people in Quebec (Canada): the PRISMA project

摘要

PRISMA is a coordinated-type model of Integrated Service Delivery for vulnerable elderly people. The PRISMA model includes the following components to enhance integration: 1) a formal mechanism to manage co-operation between decision-makers and managers of all services and organizations, 2) the use of a single-entry point, 3) a case management process, 4) individualized Service Plans, 5) a unique assessment tool with a case-mix system, 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. A significant impact of the prevalence and incidence of functional decline, satisfaction with services and empowerment was observed. There was a reduction in the number of Emergency Room visits and hospitalisations. The overall cost was not higher in the experimental group, even when implementation cost was included. The PRISMA model was then implemented throughout the province of Quebec from 2005 to 2015. Budget constraints and concomitant reforms (merging of institutions) slowed down implementation. Many lessons were learned from this implementation: case managers should be formally trained and accredited, and structural integration by merging does not necessarily foster functional integration. The PRISMA model is a good illustration of the effective transfer of research findings to a national programme, within the context of evidence-informed public policy.