Care coordination for children in rural New South Wales: barriers and enablers during early implementation

Introduction
The Rural Kids Guided Personalised Service (RuralKidsGPS) is an innovative integrated model of care coordination for children and young people living with medical complexity, in four rural local health districts across New South Wales. This study explores early implementation barriers and enablers to inform contextual adaption and ensure scalability across diverse health settings.
Methods
A mixed methods implementation evaluation informed by qualitative methods using semi-structured interviews, and focus groups with healthcare professionals, managers, parents, and children. Underpinned by the Consolidated Framework for Implementation Research (CFIR), analysis was conducted using a hybrid deductive/inductive approach to identify barriers and facilitators.

Results
The key themes highlight considerations of local context, processes, leadership, and resources as fundamental to implementation and sustainability. A strong commitment of care coordinators to implementing RuralKidsGPS whilst leveraging local knowledge and networks within health, social care and disability systems, enabled delivery of family-centred care across diverse socio-economic and cultural backgrounds. Inability to share healthcare information across jurisdictions, and staff changes have impacted the timely implementation of RuralKidsGPS and delivery of care coordination. Support from healthcare managers and professionals, and access to local resources and networks enabled nurse coordinators to adapt and implement RuralKidsGPS but streamlining workflows will be crucial for model adoption and sustainability.
Conclusion
Early findings highlight the importance of adaptation to local contexts, and the important role of care coordinators who help with navigation of complex health care systems. Ongoing implementation evaluation guided by the CFIR will further elucidate barriers and enablers of adoption and sustainability.