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author:("courier, Yves")
1.  Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people 
Introduction
The home care and services provided to older adults with the same needs are often inadequate and highly varied. Integrated care pathways (ICPs) can resolve these issues. The aim of this study was to develop the content of ICPs to follow-up frail and disabled community-dwelling older people.
Theory and method
A rigorous process was applied according to a series of steps: identification of desirable characteristics and a theoretical framework; review of evidence-based practices and current practices; and determination of ICPs by an interdisciplinary task team.
Results
ICPs are intended to prevent specific problems, maximize independence, and promote successful aging. They are organized according to a dynamic process: (1) needs assessment and assessment of risk/protection factors; (2) data-collection summary and goals identification; (3) planning of interventions from a client-centered view; (4) coordination, delivery, and follow-up; and (5) identification of variances, as well as review and adjustment of plans.
Conclusion
Once computerized, these ICPs will facilitate the exchange of information as well as the clinical decision-making process with a perspective to adequately matching the needs of an individual person with resources that delay or slow the progression of frailty and disability. Once aggregated, the data will also support managers in organizing teamwork and follow-up for clients.
PMCID: PMC3718273  PMID: 23882166
integrated care pathways; older people; disability; frailty; home care; client-centered
3.  Analysis of the continuity of services from the viewpoint of clinical files in the perspective of quality improvement 
Purpose
According to the most recent conceptual model, the continuity of services is increasingly recognized as a robust quality indicator. However, while many authors estimate that clinical files are, in principle, good observatories of continuity; very few have studied continuity from the files’ viewpoint.
Theory
Global continuity comprises three dimensions, i.e., informational continuity, management continuity and relational continuity. These three forms of continuity can be observed in clinical files by identifying continuity moments and events.
Methods
In the context of a larger embedded case study, we analyzed 21 clinical cases, equally distributed in three different integrated care networks, of users followed by case managers. Their content was decorticated using a validated clinical information extractor and then transposed to a temporal line allowing a sequential identification of continuity moments and events.
Results and conclusions
The clinical files allow a better understanding of the specific deployment patterns of the three types of continuity which appear to be dependant of the different contexts’ tools and norms of completion of the files.
PMCID: PMC3031800
continuity; quality of services; clinical files
4.  Study of the composition of the various forms of coordination in the case management practice 
Purpose
In 2004, Quebec’s Health and Social Care Ministry implemented an integrative reform aiming to systematize coordination which employed prescriptive devices. The will to systematize coordination practices is supported by formal coordination devices, such as case management. However, many obstacles lay in the path of these devices’ usage.
Theory
This presentation is based on Boltanski and Thévenot’s (1991) theory of conventions. This theory was utilized to analyze the operations that lead to the convened agreements which serve coordination in its formal and emergent aspects.
Methods
We utilized a qualitative and exploratory embedded case study design in which we employed three data collection and analysis methods: a documentary analysis of the integrative prescriptions, interviews aiming to make explicit the concrete coordination practices and direct observation of professional practices.
Results and conclusions
We identified different types of coordination systems in case management practices. Notably, the so-called ‘peri-professional’ system that grants the family caregivers the role of intermediate between the frail elder and the health and social care network, as well as the so-called ‘virtual’ system produced by the technological means of the computerized clinical files.
PMCID: PMC3031801
case management; coordination
5.  Collaboration between case managers and family caregivers in a context of integrated care for the frail elderly 
Purpose
Case management is a human device which’s purpose is to enhance the quality of services by improving their coordination. However, the case manager is not the sole bearer of the coordination duty; the first line medical doctor, the service user himself and his family caregiver may also contribute. The family caregiver represents a very important coordinator whose contribution to case management remains feebly recognized. This communication focuses on the family caregiver’s contribution to the general coordination of services.
Theory
Even though few studies have focused on family caregivers’ roles in services’ coordination, their role is recognized as crucial. Diverse models of the family caregiver’s role will be utilized to orientate our analysis of their contributions to general coordination.
Methods
Employing an embedded case study design, we conducted 18 paired interviews with user/caregiver dyads (six in three different integrated care networks) following a method aimed at making explicit their concrete coordination practices.
Results and conclusions
Services’ coordination is marked by a delay between the emergence of a clinical need and the implementation of a service, which is partially compensated by the family caregiver. Hence, global coordination is temporally out of phase with the user’s needs.
PMCID: PMC3031802
collaboration; caregivers; case managers
6.  Studying integrated health care systems with a structurationist approach 
Introduction
To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult.
Aim
Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours.
Theory and method
Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010.
Results and conclusion
To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.
PMCID: PMC3031804
integration; structuration; health care system; frail elderly; Canada
7.  The path dependency theory: analytical framework to study institutional integration. The case of France 
Background
The literature on integration indicates the need for an enhanced theorization of institutional integration. This article proposes path dependence as an analytical framework to study the systems in which integration takes place.
Purpose
PRISMA proposes a model for integrating health and social care services for older adults. This model was initially tested in Quebec. The PRISMA France study gave us an opportunity to analyze institutional integration in France.
Methods
A qualitative approach was used. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings, and administrative documents.
Results
Our analyses revealed the complexity and fragmentation of institutional integration. The path dependency theory, which analyzes the change capacity of institutions by taking into account their historic structures, allows analysis of this situation. The path dependency to the Bismarckian system and the incomplete reforms of gerontological policies generate the coexistence and juxtaposition of institutional systems. In such a context, no institution has sufficient ability to determine gerontology policy and build institutional integration by itself.
Conclusion
Using path dependence as an analytical framework helps to understand the reasons why institutional integration is critical to organizational and clinical integration, and the complex construction of institutional integration in France.
PMCID: PMC2916113  PMID: 20689740
integrated care; institutional integration; path dependence; gerontology
8.  Is the PRISMA-France glass half-full or half-empty? The emergence and management of polarized views regarding an integrative change process 
Aim
The PRISMA-France pilot project is aimed at implementing an innovative case management type integration model in the 20th district of Paris. This paper apprehends the emergence of two polarized views regarding the progression of the model's spread in order to analyze the change management enacted during the process and its effects.
Method
A qualitative analysis was conducted based on an institutional change model.
Results
Our results suggest that, according to one view, the path followed to reach the study's current level of progress was efficient and necessary to lay the foundation of a new health and social services system while according to the other, change management shortcomings were responsible for the lack of progress.
Discussion
While neither of these two views appears entirely justified, analyzing the factors underlying their differences pinpoints some of the challenges involved in managing the spread of an integrated service delivery network. Meticulous preparation for the change management role and communication of the time and effort required for a wholesale institutional change process may be significant factors for a successful integrative endeavor.
PMCID: PMC2807121  PMID: 20087426
change management; institutional change; integrated care; networks
9.  You want us to manage cases, never! Love, hate and paradoxes of the relationship of social workers with the notion of case management 
Purpose
This communication concerns the renewal of case management in favour of the aspiration to link management and intervention in a services' integration device. Three main sections are encompassed in this communication. The first consists of a brief presentation of the history and foundations of case management, the second of an analysis of the receptiveness of the primary-adoptants of a pilot-study in France to a Quebecois case management model and the last of a proposition to reproblematize questions concerning the relation between management and intervention.
Methods
This presentation is based upon a transversal observation of results of qualitative studies concerning the reception of the notion of case management by social workers. The data were composed of discursive material collected from three studies (two from Québec and one from France) with social workers who recently engaged in case management.
Results and conclusions
Even though case management arose from the patrimony of social work, its renewal raises concerns in terms of rationalization, medicalization and systematization of the discipline. These fears are partly compensated by the hope that this new function will allow social workers to base their interventions with complex clinical cases on an interdisciplinary solidarity.
PMCID: PMC2807070
case management; social workers
10.  Attributes of conception of relational continuity: an essential component of the integration of services for frail older people 
Purpose
Present the results of an exploratory study which aimed to identify the attributes of relational continuity as conceived by the actors involved in the organization of services to frail older people.
Theory
The lengthening of the duration of life with autonomy loss warrants a transformation of the response to the needs of older people. The organization of services must evolve from a hospital-centered model to a residence-centered model better adapted to long-term care. This refocus on residential care provokes a multiplication of service providers which must be coordinated to ensure continuity of care [1]. Amongst the three forms of continuity (informational, management and relational) [2], relational continuity appears as the least documented and most difficult to measure.
Methods
Twenty-seven interviews with practitioners, managers, family caregivers and users were conducted and analysed using a content analysis approach.
Results and conclusions
While the family caregivers and users stressed the psycho-affective nature of the care relationship, the practitioners viewed it as a means to ensure the adequacy of services. From the user's viewpoint, the relationship is not the responsibility of one professional, but of a collective effort that may carry his voice across the services organization.
PMCID: PMC2807069
frail older people; relational continuity; service integration
11.  Institutional integration, health and social care policy and social welfare: an application of the ‘path dependence’ theory in France 
Introduction
The PRISMA integration model is a promising method to implement integration in health and social services for elderly people. The PRISMA France study aims to investigate the implementation of this model, which relies on the establishment of advisory boards at institutional, organisational and professional levels of decision-making, in France. These boards are guided by whole systems thinking and function in a joined-up, co-ordinated manner.
Method
A qualitative approach was adopted to study the model's implementation. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings and administrative documentations. Validity was insured by triangulation methods and content saturation.
Results
Our analyses revealed the complexity, instability and fragmentation of the institutional governance of publics policies for elderly people. The ‘path dependence’ to the Bismarckian system and the incomplete reforms of gerontological policies generate a cohabitation of three concurrent policies (national, regional and local) and a juxtaposition of two institutional systems (health and social care policy and social welfare). In such a context, no institution possesses sufficient authority to determine gerontological policy.
Conclusion
In the light of these analyse, the particularly complex and time-consuming implementation of the PRISMA model in France can be better understood.
PMCID: PMC2807065
path dependency; public policies; integrated health care networks; France
12.  The PRISMA France study: implementation rate and factors influencing this rate 
Introduction
The PRISMA integration model is a promising method to implement integration in health and social services for elderly people. In the PRISMA-France study, we qualitatively studied the implementation process of this model in French settings.
Method
Our analyses were based on in-depth interviews, meeting observations and the documentation produced.
Results
We adapted the implementation scale inherent to the PRISMA model to fit the French context and, using this scale, were able to appreciate a 15% progression of implementation, from 5% to 20%, in the first 18 months of the study. The factors that contributed to this rate of progression are of three main types. To begin with, contextual factors intrinsic to the French setting complexified the incorporation of integration into the public policy agenda and the means to achieve this feat. Secondly, factors related to the background of the concerned managers and professionals were identified. Thirdly, factors related to the particularities of the PRISMA-Experiment's governance were noted. Our experience leads to consider time as the answer to these hindering contextual, professional and governance issues.
Conclusion
These observations hold an important strategic value in a time where a wider integration experimentation is planned by the ‘plan-Alzheimer’ in France.
PMCID: PMC2807061
integration measurement; factors influencing implementation; integrated health care networks; France
13.  Contributions of family caregivers to the coordination of services for the frail elderly 
Purpose
This presentation concerns the contribution of family caregivers to the coordination of services for the frail elderly.
Theory
The role of family caregivers is partly conditioned by the conjuncture of health and social care organization. In recent years, many efforts were devoted to the creation of services integration devices which aim to improve user experience in particularly fragmented services organization [1]. In this context, family caregivers increasingly draw from their personal resources to care for their loved ones. In fact, Ducharme and colleagues [2] estimated that 80% of the care received is dispensed by family caregivers. Therefore, a better understanding of the contribution of family caregivers to coordinated care was deemed pertinent.
Methods
Our exploratory study consisted of 12 interviews with family caregivers and frail elderly users concerning their coordination experience.
Results and conclusions
In all circumstances, family caregivers have an important contribution to coordination. In fact, they absorb the coordination surplus required during the pre-installation phase of case management or during the users' episodes of transforming needs. This reveals a temporal gap between the need for coordination and the effective deployment of case management. Therefore, they appear as the primary bearers of services coordination.
PMCID: PMC2807057
frail older people; family caregivers

Results 1-13 (13)