PRISMA: Program of Research to Integrate the Services for the Maintenance of Autonomy. A system-level integration model in Quebec.

Margaret Macadam

doi:10.5334/ijic.2246

Abstract

The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) began in Quebec in 1999. Evaluation results indicated that the PRISMA Project improved the system of care for the frail elderly at no additional cost. In 2001, the Quebec Ministry of Health and Social Services made implementing the six features of the PRISMA approach a province-wide goal in the programme now known as RSIPA (French acronym). Extensive Province-wide progress has been made since then, but ongoing challenges include reducing unmet need for case management and home care services, creating incentives for increased physician participation in care planning and improving the computerized client chart, among others. PRISMA is the only evaluated international model of a coordination approach to integration and one of the few, if not the only, integration model to have been adopted at the system level by policy-makers.

Highlights

The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) began with a research project in three parts of the Estrie region of Quebec in 1997
A unique feature of the PRISMA approach was its coordination and case management feature, which called for the participating agencies to share responsibility for clients but did not require merger of any providers
The PRISMA approach is embedded in a province-wide programme called RSIPA or Network of Integrated Services for the Elderly

Summary

Background

The results of the evaluation indicated that, compared to the system of care in the three comparison areas, the PRISMA model produced significant reductions in the prevalence and incidence of functional decline, lowered unmet needs, reduced emergency room visits and had an almost significant effect on reducing hospitalizations It found a significant increase in client satisfaction and empowerment. Local health and social service leaders formed a partnership among university researchers, the provincial government, regional health and social service planning and funding authorities as well as managers from the home and community care service centres This group was instrumental in creating the model of care and making resources and staff available to work on it. The long-term goal is improved care for all seniors, not just the management of services for the frail elderly

Introduction

PART 2: implementation and organisation

PART 3: impact and sustainability

Findings

Conclusions