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Centre for Health Economics and Policy Analysis


Trajectories of patient care go in confusing directions, research shows

19 Nov 2015

Is there such a thing as 'Trajectories of care' for hospital patients?

That question will be addressed by Visiting Professor François Béland at a special CHEPA seminar on Weds. Nov. 25.

Béland, who has been a visiting professor at CHEPA for the month of November, is Professor in the Health Administration Department of the Université de Montréal and also holds an appointment as adjunct professor in the Division of Geriatric Medicine in the Faculty of Medicine, McGill University. He is a co-leader of a Canadian Institutes for Health Research (CIHR) research team on fragility and aging.

His seminar draws from research he is conducting on pathways within the health care system for cancer patients, based on Québec data, from this perspective:

“Once upon a time, a question was raised by one hospital CEO. How can inpatient and outpatient care be managed in an agile way? When no response is forthcoming, the best answer is often a question: How are patients actually managed in this hospital?

“In its simplest form, patients are admitted, something is done to them, and they are discharged. These are episodes of care. Much of the work going on in the hospital is about managing these episodes. Is the collection of episodes of care so complex that each patient has its own single one, different from any other patient’s episode? Or, are episodes of care occurring in numbers small enough such that patient flow may be managed like “trajectories”? 

His presentation draws from a pilot study on trajectories of care for 394 endometrial cancer patients conducted over a two-year period at the Centre de cancer Segal, Hôpital juif de Montréal (HGJ), which identified six trajectories of care.

Data from seven HGJ administrative files on use of 16 types of inpatient and outpatient care services (cancer treatments and medical, surgical and ancillary services) were available. Trajectories were obtained with latent class analysis. Some trajectories showed high levels of access to emergency department and inpatient care with no relation whatsoever with patients’ age, cancer stage and grade, and tumor type.

He says the reasons for these varying trajectories are unresolved. 

Béland was involved in the conceptualization, implementation and evaluation of the Services intégrés pour les personnes âgées fragiles (SIPA ) demonstration project for the integrated care of the frail elderly in Montreal. SIPA is an integrated service model that draws together community services, a multidisciplinary team and case management to mobilize resources as required and according to care protocols for frailty elderly patients.

Béland studied sociology at the Université de Montréal and Université Laval. He obtained a PhD in sociology from Université Laval in 1978 and pursued post-doctoral studies at School of Public Health, University of Michigan. Since then, he has been involved in social gerontology studies, health services research, and program evaluation.

He is co-director of Solidage, the Université de Montréal \ McGill University Research Group on Frailty and Aging, and member of the Institut de recherche en santé publique de l’Université de Montréal (IRSPUM). He has authored more than 170 papers and presented more than 300 papers at scientific conferences.

The seminar will be held on Weds. Nov. 25 from 12:30 to 1:30 in CRLB-119. All are welcome. The seminar will be available remotely for those unable to attend.

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