Université de Versailles St-Quentin, Laboratoire Santé Vieillissement, AP-HP, Hôpital Sainte Perine, Paris, France.
Aging Clin Exp Res. 2009 Dec;21(6):414-23. doi: 10.1007/BF03327446.
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.
尽管综合系统的疗效有充分证据，但要确保卫生专业人员，特别是初级保健医生（PCP）的参与，已被证明是困难的。需要新的方法来解决这些问题。我们开发了一种模型 - COPA - 它基于科学证据和一个原始的设计过程，其中包括 PCP 在内的卫生专业人员和管理人员积极参与。COPA 的目标是针对通过其 PCP 招募的非常脆弱的社区居住的老年人。它旨在提供更符合老年人服务需求的服务，以减少过度的医疗保健使用，包括不必要的急诊室（ER）就诊和住院治疗，并防止不适当的长期疗养院安置。该模型的创新性在于：1）加强了 PCP 所扮演的角色，包括患者招募和护理计划制定；2）将卫生专业人员整合到一个多学科的初级保健团队中，其中包括与 PCP 密切合作进行老年评估（InterRAI MDS-HC）并实施护理管理计划的病例经理；3）通过引入老年病医生到社区中为患者看病并组织直接住院，同时保持 PCP 对医疗决策的责任，从而整合了初级医疗保健和专业护理。由于 COPA 目前既是一项准实验研究又是一项定性研究的主题，我们也提供了初步的研究结果。这些结果表明该模型是可行的，并且得到了 PCP 和患者的广泛认可。此外，我们的结果表明，COPA 的服务利用率水平低于全国报告水平，而护理质量没有任何妥协。
