Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people

<strong>Introduction:</strong> 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 disable...

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Main Authors: Nicole Dubuc, Lucie Bonin, André Tourigny, Luc Mathieu, Yves Couturier, Michel Tousignant, Cinthia Corbin, Nathalie Delli-Colli, Michel Raîche
Format: Article
Language:English
Published: Ubiquity Press 2013-05-01
Series:International Journal of Integrated Care
Subjects:
Online Access:http://www.ijic.org/articles/976
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author Nicole Dubuc
Lucie Bonin
André Tourigny
Luc Mathieu
Yves Couturier
Michel Tousignant
Cinthia Corbin
Nathalie Delli-Colli
Michel Raîche
author_facet Nicole Dubuc
Lucie Bonin
André Tourigny
Luc Mathieu
Yves Couturier
Michel Tousignant
Cinthia Corbin
Nathalie Delli-Colli
Michel Raîche
author_sort Nicole Dubuc
collection DOAJ
description <strong>Introduction:</strong> 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. <strong>Theory and method:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> 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.
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spelling doaj.art-46f0d6441b73429eb1025a055e0386312022-12-22T03:35:53ZengUbiquity PressInternational Journal of Integrated Care1568-41562013-05-0113210.5334/ijic.9761000Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older peopleNicole DubucLucie BoninAndré TourignyLuc MathieuYves CouturierMichel TousignantCinthia CorbinNathalie Delli-ColliMichel Raîche<strong>Introduction:</strong> 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. <strong>Theory and method:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> 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.http://www.ijic.org/articles/976integrated care pathwaysolder peopledisabilityfrailtyhome careclient-centered
spellingShingle Nicole Dubuc
Lucie Bonin
André Tourigny
Luc Mathieu
Yves Couturier
Michel Tousignant
Cinthia Corbin
Nathalie Delli-Colli
Michel Raîche
Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people
International Journal of Integrated Care
integrated care pathways
older people
disability
frailty
home care
client-centered
title Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people
title_full Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people
title_fullStr Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people
title_full_unstemmed Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people
title_short Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people
title_sort development of integrated care pathways toward a care management system to meet the needs of frail and disabled community dwelling older people
topic integrated care pathways
older people
disability
frailty
home care
client-centered
url http://www.ijic.org/articles/976
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