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Conference Abstracts

Implementing a Care Coordination Strategy for Children with Medical Complexity in Ontario, Canada: A Process Evaluation

Authors:

Samantha Quartarone ,

The Hospital For Sick Children, Toronto, Canada, CA
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Jia Lu Lin

The Hospital For Sick Children, Toronto, Canada, CA
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Abstract

Introduction: There is a growing population of children with medical complexity (CMC), defined as those children with chronic conditions who have functional limitations, elevated service needs and high healthcare utilization. CMC and their families interact with multiple services along the care continuum and frequently experience gaps in care due to fragmented services. A provincial strategy to expand care coordination and integration of care for CMC was launched in Ontario, Canada in 2015. A process evaluation of the roll-out examined the processes, mechanisms of impact, and contextual factors affecting the implementation of the Complex Care for Kids Ontario (CCKO) intervention strategy.

Methods: The aims of this study were: i) to understand the processes involved in CCKO implementation; ii) to investigate the mechanisms of impact and how they led to intervention effects; and iii) to understand the barriers and facilitators influencing the implementation of the CCKO intervention across various settings. To evaluate the implementation of the CCKO intervention, a multi-method study design was used, including semi-structured interviews with 38 key informants and 10 families of CMC involved in CCKO. To further understand implementation details across regional sites, provincial-level implementation plans, and process documents were reviewed. This process evaluation was conducted and analyzed according to the United Kingdom Medical Research Council (UK-MRC) process evaluation framework.

Results: Through qualitative investigation we explored the causal mechanisms and intermediate processes through which the delivery of CCKO was achieved and produced its effects on CMC and their families. Study participants perceived that CCKO’s effectiveness was attributable to four main mechanisms: 1) Complex Care Plan: having a well-defined process for complex care plan creation assumed by a clinical key worker with specialized knowledge about the medical conditions and systems of care; 2) Care Coordination: establishing clear roles for care team members and opportunities for care providers to engage in ongoing learning, mutual sharing, and collaborative problem-solving; 3) Clinical Key Worker: having a clinical key worker who understands the patient’s medical history and upkeeps a trusting relationship with the family; and 4) Timely Access to Care for Acute Needs: establishing a structured mechanism for families to access timely and reliable medical assessment and guidance should urgent situations arise. 

Conclusion: This study adds to understanding the processes involved in developing a population-level care coordination intervention strategy for CMC. Strengths of CCKO included novel collaborations and partnerships between complex care teams, community partners and regional sites. Issues relating to communication and coordination across care sectors created challenges to care coordination objectives.

Implications: Lessons learned through CCKO can help facilitate reproducibility and necessary adjustments of the intervention in different settings. Ongoing work to implement and expand models of care for CMC will benefit from complex care services closer to home, strong cross-regional and interorganizational partnerships, sufficient program funding, a well-trained team with expertise in complex care and family engagement.

 

 

 

How to Cite: Quartarone S, Lin JL. Implementing a Care Coordination Strategy for Children with Medical Complexity in Ontario, Canada: A Process Evaluation. International Journal of Integrated Care. 2022;22(S3):6. DOI: http://doi.org/10.5334/ijic.ICIC22001
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Published on 04 Nov 2022.

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