Monitoring the degree of implementation of an integrated delivery system

INTRODUCTION: 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. METHOD: 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. RESULTS: 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. DISCUSSION: 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

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Famille, vieillissement, territoire et innovation sociale

Ce numéro thématique s’intéresse aux principaux enjeux et défis associés au vieillissement démographique en regard de l’amélioration de l’inclusion sociale et de la qualité de vie des aînés. Les articles qui le composent mettent en exergue le remodelage du lien social entre les personnes âgées, le territoire, leur famille et l’ensemble de la société en s’appuyant sur divers cas au Québec et en France. Ceux-ci touchent la retraite en milieu agricole, les stratégies déployées face aux difficultés financières, les impacts du vieillissement sous la loupe de l’aménagement urbain, la démarche « Municipalités amies des aînés » et le soutien aux proches aidants. Enfin, trois articles Hors thème complètent ce numéro. Le premier traite de la séparation conjugale ; le deuxième du soutien parental dont bénéficient des jeunes trans ; le dernier s’intéresse aux relations de jeunes adultes ayant été exposés à de la violence conjugale dans leur enfance ou adolescence