Calendrier du programme de recherche: mars 2011- décembre 2014
Porteurs du programme: Alice Teil ; Geneviève Derumeaux (HCL-Hôpital Louis Pradel) ; Valérie Buthion (COACTIS EA 41611) ; Nora Moumjid (GATE LSE CNRS UMR 5824), Pascal Briot (Institute for Health Care Delivery Research- Intermountain Healthcare-US)
This project starts from the realization that, within healthcare regions and in particular for the treatment of chronic diseases, developing health services integration dynamic through a territorial governance relying on coordination and collaboration mechanisms is an important factor in developing clinical pathways, improving outcomes, reducing treatment disparities, and controlling costs.
This realization calls for studying effective methods of dynamic integration for improving the three performance criteria cited above. The scientific literature identifies organizational key success factors in terms of the set of structure, tools, resources and incentives conditions. But it seems that in spite of numerous efforts to develop them at national, regional and local level, the system remains fragmented. Barriers are numerous ranging from the legal to the financial environment, and including cultural and educational limitations. Integrating care pathways means more than developing the right tools, it is also about developing the culture of collective decision-making and action-taking in a system that is both not designed and used to that.
This research project aims to identify the 1) organizational conditions, 2) leverage points, and 3) dynamics of an ever changing patient-centered process that can result in improving outcomes, reducing treatment disparities, and controlling costs. Five tasks structure the research.
Task 1, “strategic mapping for governance,” aims to build a dynamic tool for the governance of organizing the different stakeholders for a collective decision-making processes. It intends for every stakeholder in the delivery of care process to share information so as to create and organize integrated patient-centered care delivery pathways.
Task 2, “clinical system”, creates an inventory of all the activities (clinical and administrative) required to develop a continuous clinical pathway for heart failure patients. It will rely on the other tasks (1, 3-5) for its development and it will constitute the scientific foundation/platform for all the other tasks.
Task 3, “patients’ preferences,” aims to study the methods of patients’ involvement in clinical decision making processes related to their treatment. It aims to understand the extent to which patient’s involvement impacts access to treatment and creates disparities in wellness.
Task 4, “Management Control and Finance,” aims to build an assessment, evaluation and feedback system based on sets of individual measures, collective evaluations, and designed adjustments to make to the processes. It intends to install the creation of a balanced scorecard using a wider range of measures especially on patient-centered outcomes, as the foundations for strategic decisions.
Task 5, “modeling and dissemination,” aims to study the mechanisms of appropriation of tools along the organizing process triad “mediating/acting/sensemaking. Methods and principles will be identified and characterized in order to develop training programs for professionals.
This project uses the method of case study combining qualitative data (social observation, interviews) and quantitative data (patient registry).
Our expected results will improve our scientific knowledge :
(1) in medicine: regarding the impact of new collaborative care practices on outcomes;
(2) in management, regarding the necessary conditions needed for integration dynamic for patients’ sustainable outcomes, lower disparities and cost control;
(3) in micro-economics, regarding patients’ preferences and the impact they have when they are applied in the care decision process.