Monitoring the degree of implementation of an integrated delivery system

The aim of the study was to develop a method to measure the implementation of specific components of an Integrated Service Delivery system for the frail elderly. The system includes six mechanisms and tools: (1) coordination of all organizations involved in delivering health and social services, (2) a single entry point, (3) case management, (4) a single assessment tool with a case-mix classification system, (5) an individualized service plan, and (6) a computerized clinical chart.

Focus groups of researchers, clinicians, managers and policy-makers identified quantitative indicators for each component. The six components were weighted according to their relative importance in order to generate a total score. Data were collected every six months over 30 months to establish the implementation degree in the three experimental areas: Sherbrooke, Granit and Coaticook in the Province of Quebec, Canada.

After 30 months, coordination is the most developed component in the three experimental areas. Overall, in July 2003, the Integrated Service Delivery system was implemented at the rate of 73%, 71% and 70% in Sherbrooke, Granit and Coaticook, respectively.

This type of quantitative assessment provides data for managers and researchers to monitor the implementation. Moreover, when there is an outcome study, the results of the outcome study can be correlated with the degree of implementation, thus allowing for dose-response analyzes and helping to decrease the "black box" effect.