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

Samantha Quartarone; Jia Lu Lilian Lin; Julia Orkin; Nora Fayed; Simon French; Nathalie Major; Joanna Soscia; Audrey Lim; Sanober Diaz; Myla Moretti; Eyal Cohen

doi:10.5334/ijic.6073

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

Int J Integr Care. 2022 Apr 28;22(2):9. doi: 10.5334/ijic.6073. eCollection 2022 Apr-Jun.

Authors

Samantha Quartarone¹, Jia Lu Lilian Lin², Julia Orkin^{1

3

4}, Nora Fayed⁵, Simon French⁶, Nathalie Major⁷, Joanna Soscia³, Audrey Lim⁸, Sanober Diaz⁹, Myla Moretti^{1

10}, Eyal Cohen^{1

2

3

4

11

12}

Affiliations

¹ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, CA.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CA.
³ Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, CA.
⁴ Department of Paediatrics, University of Toronto, Toronto, Ontario, CA.
⁵ School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, CA.
⁶ Department of Chiropractic, Macquarie University, Sydney, AU.
⁷ Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, CA.
⁸ Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, CA.
⁹ Provincial Council for Maternal and Child Health, Toronto, Ontario, CA.
¹⁰ Clinical Trials Unit- Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, CA.
¹¹ ICES, Toronto, Ontario, CA.
¹² Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, CA.

Abstract

Introduction: A provincial strategy to expand care coordination and integration of care for children with medical complexity (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: This process evaluation was conducted and analyzed according to the United Kingdom Medical Research Council (UK-MRC) process evaluation framework. 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.

Discussion: 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 holistic care coordination objectives. Provincial system fragmentation limited the ability of CCKO to provide seamless care coordination due to the multiple care sectors involved.

Conclusion: This study adds to the understanding of the processes involved in a population-level care coordination intervention for CMC. Lessons learned through CCKO can help facilitate reproducibility and necessary adjustments of the intervention in different settings.

Keywords: care coordination; child; complex care; family; medical complexity; process evaluation.

Publication types

Case Reports

Grants and funding

This study was funded by the Canadian Institutes of Health Research (funding reference number: FDN-143315).