title: Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership.
abstract: BACKGROUND
  Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs).
  
  
  OBJECTIVE
  To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs.
  
  
  RESULTS
  In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase.
  
  
  CONCLUSIONS
  The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements.
authors.affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Sainte Périne, Pole Ambulatoire Diagnostic et Intervention en Santé, 49 rue Mirabeau, 75781 Paris Cedex 16, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: de Stampa
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vedel
authors.forename: Claire
authors.initials: C
authors.lastname: Mauriat
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bagaragaza
authors.forename: Christelle
authors.initials: C
authors.lastname: Routelous
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
authors.forename: Liette
authors.initials: L
authors.lastname: Lapointe
authors.forename: Bernard
authors.initials: B
authors.lastname: Cassou
authors.forename: Joel
authors.initials: J
authors.lastname: Ankri
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Henrard