HOW IT WORKS
PAERPA aims to improve quality of care, prevent loss of autonomy, and reduce hospital use among the frail elderly through various internal activities aimed at improving collaboration between local health and social service providers. The program has three distinct initiatives:
- Preventive actions against the risk of depression, malnutrition polypharmacy, or falls (including training providers on how to locate therapeutic services).
- Actions improving links between professionals, including implementation of mobile teams, telemedicine, night nurses in retirement homes, respite stays for caregivers, and frailty screenings in hospital.
- Coordination actions, including a unique information platform, personalized health plan, and digital tools.
The personalized health plan innovation, created for the program by Haute Autorité de Santé (HAS), is a new type of funding innovation that provides an assessment of a patient’s health and social care needs. A GP, along with a nurse, pharmacist, or a physiotherapist, perform the intake for a split fee. The Territorial Coordination Support system (TCS) is an integrated information platform (accessible via a single phone number) that provides information to patients, families, and health and social service professionals about the services available.
An evaluation compared key outcomes in the first two years, including 30-day readmissions, emergency room use, avoidable hospitalizations, and measures of polypharmacy and inappropriate prescriptions between nine regions with PAERPA programs and control regions. It found no statistical difference in these indicators overall but some improvements in prescribing in two regions. Further analyses of utilization, outcomes, quality, costs, and provider and patient satisfaction are forthcoming. In 2017, PAERPA was expanded to an additional nine regions. The program has served more than 700,000 patients to date.
For providers. Primary care providers manage patients as part of their wider case loads. GPs lead patient care activities, while the TCS organizes social services. The operational data platform to share patient care information among providers is being set up in each territory. Most sites already use secure messaging systems, but since not all health professionals are logged in, this type of data-sharing is still only partly occurring.
For patients/caregivers. The program promotes patient self-efficacy and empowerment, with formal support provided for patient education and caregivers support. PAERPA’s educational objectives are to inform older people who live at home about major risks and to discuss services offered by home health and social care providers. The TCS provides health care providers with information on existing devices, participating health and social service providers, individual care planning, and administrative procedures.
The TCS, devoted exclusively to the elderly, is unique to PAERPA. Each territory has some responsibility for monitoring a variety of measures of program performance and helping to resolve challenges in care and social services. The National Agency for Support to the Performance of Health and Medical-Social Facilities (ANAP) created this national platform and continues to collect data from each region and perform benchmarking every trimester.
Funding for PAERPA comes from the French health ministry’s budget for funding quality improvement initiatives. Most providers in France are paid through a fee-for-service model. This program maintains that arrangement but provides extra funding for specific services, mostly dedicated to coordination.
Contact: Alexandre Farnault, National Manager
Additional information on impact: Impact Evaluation of Pilots for Improving "Healthcare Pathways of Seniors" (PAERPA): Initial Findings, https://www.irdes.fr/english/issues-in-health-economics/235-impact-evaluation-of-pilots-for-improving-healthcare-pathways-of-seniors-paerpa.pdf