Quartarone Samantha, Lin Jia Lu Lilian, Orkin Julia, Fayed Nora, French Simon, Major Nathalie, Soscia Joanna, Lim Audrey, Diaz Sanober, Moretti Myla, Cohen Eyal
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, CA.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CA.
Int J Integr Care. 2022 Apr 28;22(2):9. doi: 10.5334/ijic.6073. eCollection 2022 Apr-Jun.
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.
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.
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.
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.
2015年，加拿大安大略省启动了一项扩大医疗复杂儿童（CMC）护理协调与整合的省级战略。对该战略推出过程的评估考察了安大略省儿童复杂护理（CCKO）干预战略实施过程、影响机制及相关背景因素。
本过程评估依据英国医学研究理事会（UK-MRC）过程评估框架进行实施与分析。为评估CCKO干预措施的实施情况，采用了多方法研究设计，包括对38名关键信息提供者以及参与CCKO的10名CMC患儿家庭进行半结构化访谈。为进一步了解各地区实施细节，还查阅了省级实施计划及过程文件。
CCKO的优势在于复杂护理团队、社区合作伙伴及地区站点之间建立了新颖的合作关系。各护理部门间沟通与协调问题给整体护理协调目标带来了挑战。由于涉及多个护理部门，省级系统碎片化限制了CCKO提供无缝护理协调的能力。
本研究增进了对CMC人群层面护理协调干预过程的理解。通过CCKO吸取的经验教训有助于促进该干预措施在不同环境下的可重复性及必要调整。
