title: Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada.
abstract: BACKGROUND
  Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery.
  
  
  METHODS
  Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases.
  
  
  CONCLUSIONS
  Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management. Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care.
authors.affiliation: Solidage-McGill University-Université de Montreal Research Group on Frailty and Aging, Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vedel
authors.forename: Michele
authors.initials: M
authors.lastname: Monette
authors.forename: François
authors.initials: F
authors.lastname: Beland
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman