Evaluating the Implementation of Three Integrated Care Programs for Older Adults with Major Neurocognitive Disorders
Bibliographic record
Abstract
Federal and provincial governments in Canada have mobilized resources to address the challenges of care associated with the growing population of older adults with major neurocognitive disorders (MND), which include Alzheimer's and other related diseases. Researchers and practitioners in Québec, Ontario, and Saskatchewan identified a need for better integrated care for older adults with MND, improved capacity for assessment, diagnosis, and management of cases, as well as greater accessibility for those living in rural and remote regions. To this end, three distinct programs---the Réseau de services intégrés pour personnes âgées en perte d'autonomie cognitive (RSI-PAPAC) in Québec, the Primary Care Collaborative Memory Clinic (PCCMC) in Ontario, and the Rural and Remote Memory Clinic (RRMC) in Saskatchewan---were developed with the help of funding from provincial governments and federal research grants. The objective of this article is to compare and analyze the implementation and performance of these programs. Each program saw a large scope of services offered with the integration of community services and a great degree of coordination between these actors. The RSI-PAPAC was a roster program implemented in a collection of community health centres in Québec, while the latter two were clinical models that originated out of one central clinic. In Québec, while the specific program we analyzed is no longer active today, the ministry of health and social services has since adopted a comprehensive action plan rolling out services at a provincial scale (unrelated to the program we analyzed). In Ontario, with the help of interested organizations, the PCCMC has since been scaled up across the province, with over 100 clinics now active. It was easily adopted due to the quick training program offered to physicians and its reliance on patients' existing circle of care. Finally, in Saskatchewan, the RRMC has not scaled up to other clinics, likely due to the lack of existing collaborative primary clinics such as those in Ontario; however, provincial governments and other health organizations have mobilized to fund its continuation, and it currently operates out of one clinic in Saskatoon, serving as a node of care and research within the University of Saskatchewan.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".