Case management practices in the integraded care network for frail elderly individuals in Québec: Innovative home-centric care or renewed in-hospital care?
Mots-clés :
Intégration des services, coordination des services, gestion de cas, personnes âgées, soutien à domicileRésumé
Background: Since the 1990's, the government of Québec undertook a shift called virage ambulatoire (ambulatory care) in its delivery of health care and social care services. In response to a number of coordination related problems between various interprofessional and interinstitutional actors engendered by the implementation of the ambulatory model, that we call home-centric, Québec's Ministry of Health and Social Services decided to implement a major reform pertaining to services integration. This reform facilitated the implementation of different coordination devices, including the professional device of case management. In this article, our goal is to analyse how case management, in the specific context of integrated care networks for frail elderly individuals, contributes to home-centric governmental policies. Methodology: We conducted a qualitative exploratory study using an embedded case study design. In each of the three Health and Social Services Centres covered by our study, we used three data collection methods: a documentary analysis, face-to-face interviews, and direct observation of case mangers practices. Results: We note that coordination with hospitals remains at the center of case managers' activities, diverting in part their function regarding home care towards hospitals' needs, where rapid discharge planning of short-term care beds is still viewed as a priority.
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