Table 1.

List of indicators used to rate the implementation of the ISD system

Indicators	Rating
	(pts)
Coordination	20
1. Presence of a structure designed to enhance cooperation between partners	3
2. All partners concerned represented	3
3. Representatives stability over time	3
4. Representatives participate regularly	3
5. Partners informed of how services are changing (or not changing)	4
6. Partners criticize the organization of the services change process	4
Single entry point	20
1. Presence of a single entry point in each local area	5
2. Clearing functions done by dedicated professionals	5
3. Professionals use a validated screening instrument to identify eligible frail elderly	5
4. Follow-up with older people in the group at high risk of functional decline	5
Case management	20
1. Variation between actual number of case managers and number needed according to proportion of senior citizens in the area	10
2. Variation (above or below) between actual average caseload and recommended caseload (45)	10
Single assessment tool and case-mix classification	15
1. Percent of clients under case management evaluated with SMAF tool	5
2. Percent of partners systematically using SMAF tool with their elderly patients	5
3a. Use of the case-mix classification system (ISO-SMAF profiles) for efficient utilization of resources	5
3b. Use of the ISO-SMAF profiles system as a new standard for financing services
Computerized clinical chart	15
1. Availability of a computer program for sharing clinical information in real time	5
2. Sufficient number of computers for all partners	5
3. Utilization of the computerized computer chart by partners	5
Individualized service plan	10
1. Percent utilization of the individualized service plan by case managers (as indicated in the clinical files of patients under case management)	10
TOTAL	100