Why implementing in France a coordination support system for the coordination of patient pathways at the regional level? Since the modernization law of January 26, 2016, the coordination of professionals has been identified as a major issue to ensure quality patient care, while implementing the ambulatory shift. The new care models, focused on home care and the inclusive approach, have also reinforced the need for coordination support structures to assist primary care professionals in the construction and implementation of a smooth pathway for people. However, their multiplicity (health networks, MAIA, CLIC, CTA PAERPA, PTA, etc.) limits the legibility of this service for both health professionals and users.
Alcimed looks back on its support for LRAs in setting up coordination support systems (DAC in French), a new public policy tool that seeks to provide clarity and efficiency in terms of patient pathway.
What is a Coordination Support System (DAC)?
DACs to consolidate coordination support structures by 2022
The coordination support systems deployed within the framework of the Act of 24 July 2019 on the organization and transformation of the health system are a tool to support the coordination of professionals in the management of complex care pathways.
DACs can be deployed at the departmental, infra-departmental or supra-departmental level. The aim of this system is to integrate all the coordination mechanisms in place in the territory in which it operates: methods of action for the integration of aid and care services in the field of autonomy (MAIA), territorial support platforms (PTA), tri-thematic territorial health networks, territorial support coordination (CTA) and possibly local gerontological information and coordination centers (CLIC).
All of these converging structures address different populations and situations. The DACs thus aim to improve the legibility of the offer on the territories and to limit the silo functioning of the health, social and medico-social sectors by widening their field of action to intervene with people of all ages and all pathologies.
3 main missions to support professionals and users
The establishment of a DAC has three main missions:
1. Responding to requests for support from professionals. Thanks to its unique number, the DAC receives requests for information or support from professionals faced with a health, social or medico-social problem. The DAC is then responsible for receiving the request, analyzing the situation, directing the professional making the request, and even intervening on behalf of the attending physician in monitoring the person’s situation.
2. Contribute with other actors and in a coordinated way to meet the needs of people and their caregivers. The response may take the form of referral to relevant services in the area or an assessment and monitoring of the person’s situation according to the problem identified.
3. Participate in territorial coordination. The aim is to involve all the partners of the territory in projects and themes related to the needs of the territory.
What is the process for setting up a DAC?
A deployment strategy defined by the LRAs
The formalization of a DAC is subject to a set of criteria defined by each SRA. Some LRAs may have chosen to draw up a reference framework for the mission and organization of the DACs in order to support local players in this restructuring, as is the case for the Ile-de-France LRA.
Alcimed’s feedback on the creation and structuring of a coordination support system
Alcimed has supported different territories at the regional and local level in the constitution and labelling of coordination support systems and has highlighted five key areas of work for this implementation.
The first two steps are to be carried out concomitantly to feed the following:
1. The legal structuring and governance of the DAC: the legal form of the DAC is free even if the associative model remains to be favored. It can, for example, take the form of a merger-creation or a merger-absorption. It is necessary to allow at least 6 months between the analysis of the expectations and the finalization of the association’s statutes.
2. The implementation of the service project concerns the operational application of the DAC. A service project aims to identify the organizational and functional modalities of the DAC, both internally and at the territorial level, to formalize the mapping of its skills and human resources and to design its provisional budget. Working on this service project is also a pretext for creating a common culture between the different teams that will converge through the sharing of objectives and their operational implementation.
Our support has highlighted a two-fold dynamic in supporting the structuring of DACs: proactive ARS and those awaiting publication of the National Orientation Framework.
Among the perspectives identified in order to facilitate territorial integration dynamics is the interest of the DACs to engage more broadly in the restructuring and integration dynamics of the first application at the local level. The challenge of making the DACs more transparent can only be met by forging close links with the local health professional communities (CPTS) and local hospitals, and by involving all the players in the first application. It is the responsibility of the supervising authorities to reach agreement with the Departmental Councils in order to strive for optimal integration in the territories.
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About the authors
Coralie, Consultant in Alcimed’s Public Policy team in France
Marie-Sophie, Head of Alcimed’s Public Policy activity in France
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