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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Advance Access published online on May 4, 2009
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, doi:10.1093/geronb/gbp027
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Impact of PRISMA, a Coordination-Type Integrated Service Delivery System for Frail Older People in Quebec (Canada): A Quasi-experimental Study

Réjean Hébert1,2, Michel Raîche2, Marie-France Dubois1,2, N'Deye R. Gueye2, Nicole Dubuc1,2, Michel Tousignant1,2 and The PRISMA Group

1 Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
2 Research Centre on Aging, Sherbrooke Geriatric University Institute, Sherbrooke, Québec, Canada

Address correspondence to Réjean Hébert, MD, MPhil, Research Centre on Aging, Sherbrooke Geriatric University Institute, 1036 Belvédère Sud, Sherbrooke, Québec, Canada J1H 4C4. Email: Rejean.Hebert{at}USherbrooke.ca


  Abstract

Objectives: To evaluate the impact of a coordination-type integrated service delivery (ISD) model on health, satisfaction, empowerment, and services utilization of frail older people.

Methods: Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is a population-based, quasi-experimental study with three experimental and three comparison areas. From a random selection of people 75 years or older, 1,501 persons identified at risk of functional decline were recruited (728 experimental and 773 comparison). Participants were measured over 4 years for disabilities (Functional Autonomy Measurement System), unmet needs, satisfaction with services, and empowerment. Information on utilization of health and social services was collected by bimonthly telephone questionnaires.

Results: Over the last 2 years (when the implementation rate was over 70%), there were 62 fewer cases of functional decline per 1,000 individuals in the experimental group. In the fourth year of the study, the annual incidence of functional decline was lower by 137 cases per 1,000 in the experimental group, whereas the prevalence of unmet needs in the comparison region was nearly double the prevalence observed in the experimental region. Satisfaction and empowerment were significantly higher in the experimental group. For health services utilization, a lower number of visits to emergency rooms and hospitalizations than expected was observed in the experimental cohort.

Conclusion: The PRISMA model improves the efficacy of the health care system for frail older people.

Key Words: Aged • Case-management • disability • Frailty • Health services • Integrated service delivery systems

Received July 2, 2008; Accepted February 25, 2009

Decision Editor: Kenneth F. Ferraro, PhD


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