33 Participant observation will take place during quarterly meeti

33 Participant observation will take place during quarterly meetings (principal investigators) with the Director-generals, CM programme directors and two clientele representatives in the

HSSC and during meetings of the committees designated to organise care for high users (research assistants). Data will be collected using a logbook and field notes.38 3.Document http://www.selleckchem.com/products/Calcitriol-(Rocaltrol).html analysis (qualitative data) The analysis of documents on the subject of programme implementation will serve to corroborate and complete the information obtained through the other data collection methods.40 Two main sources of documents will be used: documents on the CM programme of high users of services and meetings records of the committees designated with the organisation of care for high users. 4.Clinical and administrative data (quantitative) Utilisation of services will be considered from an organisation perspective. This way, the number of high users of emergency and hospitalisation services and the ratio

of high user visits/total visits will be determined monthly for each HSSC using the already operational Magic Chronique computer application, which uses interfaces that are similar in all four HSSC. In the absence of a consensus definition of frequent users in the literature, the one retained at a regional scale will be used (six visits or more to the emergency room in the past year or 3 hospitalisations or more). The ratio compiling all high user visits/total visits will also be determined for each HSSC. Quality of data will be controlled using an integrated model of information quality and using a series of algorithms for the validation of data. These data

will also be collected retrospectively for all HSSCs (on a monthly basis in the year preceding the start-up of the project). 5.Questionnaires (quantitative data) Each project year will coincide with the recruitment of the new cohort of high users in the CM programme of each HSSC for a period of 1 year. The French-language questionnaires, in which metrological qualities are well documented Cilengitide and adequate, will be administered, following informed consent, to all persons (100 patients from the HSSC of Chicoutimi and HSCC of Jonquière, and 75 patients from the HSSC of Alma and HSSC of La Baie) at entry into the CM programme (sociodemographic questionnaire, health literacy, patient activation, multimorbidity and quality of life) and at 6 months and 1 year (quality of life). The sociodemographic questionnaire will assess age, sex, income and education of the participants. Literacy will be measured using the Newest Vital Sign41 and patient activation with the Patient Activation Measure.42 43 Multimorbidity will be evaluated with the Disease Burden Morbidity Assessment by self-report44 45 and quality of life, using the SF-12v2.

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