[Organization of care and services for stroke to optimize access to endovascular treatment in Quebec]

Azzi L, Boothroyd L, Lambert L, Nicolae MV
Record ID 32018000892
Original Title: Organisation des soins et services pour la prise en charge des accidents vasculaires cérébraux afin d’optimiser l’accès au traitement endovasculaire au Québec
Authors' objectives: The public health and social services system in Quebec is characterized by its integration of health services, social services and public health services. This integration lies at the heart of the vision of population-based responsibility and offers the potential to create substantial value for users, notably for seniors, who often have multiple or complex health problems. As more and more investment is being made in the Support for Elderly Autonomy Program (SAPA), it is essential to assess this program in order to optimize the value that it affords the people of Quebec.
Authors' results and conclusions: RESULTS: Highlight the centrality of responsiveness, continuity and effectiveness when assessing the quality of senior care and services. Responsiveness is defined as the ability of the health care system to adapt to the values and expectations of the population, whereas effectiveness represents the healthcare system’s capacity to improve the health and wellness of the population. Continuity occurs when users perceive a clear link between the various care and services components. The data collected also indicates that the assessment approaches and traditional indicators, taken in isolation, have limits that prevent a full understanding of the many nuances related to the quality of the senior care and services continuum. Four avenues for effecting improvements are thus proposed. CONCLUSIONS: enhance the assessment of the quality of the care continuum by clearly identifying the priority quality dimensions for seniors and their caregivers, and by proposing an indicator inventory and suggesting avenues to guide improvement in measurement.
Authors' methods: A report and a state of knowledge have been published. The report is intented to support the MSSS with respect to assessing the senior care and services continuum; it does so by reviewing the literature and suggesting quality-assessment indicators and approaches. The state of knowledge incorporates scientific data culled over the course of four literature reviews; contextual data derived from the grey literature for construction of an indicator inventory; and experiential data collected during a consultation of experts that focused on the preferred indicators for assessing the SAPA continuum. The first literature review did not allow to identify comprehensive measurement and assessment frameworks for integrated senior services in jurisdictions comparable to Quebec. This finding corroborated the relevance of the procedure but also raised the need to approach the continuum assessment from a different angle, i.e., from the users’ point of view. Consequently, the second literature review examined seniors’ health needs and preferences. The priorities of seniors include improving physical and mental health, safety, autonomy, reducing caregiver burden and communicating information to users about their health status. These results provide an essential perspective for purposes of assessing the quality of the senior care and services continuum.
Authors' identified further reserach: A search of 72 grey literature documents identified a very substantial number of potential indicators for assessing the quality of the SAPA continuum and each of its components. These indicators were analyzed, classified and selected for inclusion via the construction of typical trajectories that illustrate the optimal path for users as they make their way through the senior care continuum. By mapping the comprehensive continuum (hyperlink) and five typical trajectories (hyperlink), it was possible to highlight areas of weakness in the users’ journeys and to determine indicators that could be used to monitor them. Finally, the indicator inventory (hyperlink to web site – forthcoming) contains 282 indicators presenting a balanced distribution of the various levels of management (strategic, tactical and operational) together with structure, process and outcome indicators.
Project Status: Completed
Year Published: 2019
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Stroke
  • Emergency Medical Services
  • Brain Ischemia
  • Endovascular Procedures
  • Thrombectomy
  • Delivery of Health Care
  • Health Services Accessibility
  • Transportation of Patients
  • Stroke
  • Intravascular ultrasound
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.