Implementation of a paediatric integrated model of care in rural regions of Australia: experiences, barriers, and enablers from the frontline

Introduction: Limited care coordination and planning for children living with medical complexity (CMC) leads to missed and duplicated care, increasing costs for the health system and families, compounded by living rurally, necessitating enhanced local solutions. The Rural Kids Guided Personalised Service (RuralKidsGPS) is an integrated model of care coordination, implemented in four rural local health districts across New South Wales, Australia. RuralKidsGPS aims to improve experiences and to smooth pathways through healthcare by connecting CMC to local health services, coordinating care and care teams, and building families capacity for self-care. This study aims to explore implementation barriers and enablers by analysing the experiences of staff delivering RuralKidsGPS, during the first 6 months of implementation. The analysis aims to inform future implementations, contextual adaption plans for scaling the model across diverse health settings.
Methods: A mixed methods implementation evaluation informed by qualitative methods using semi-structured interviews with nurse coordinators (N=4), healthcare professionals (N=11), health managers (N=4) and embedded researchers (N=4). Underpinned by the Consolidated Framework for Implementation Research (CFIR), thematic analysis was conducted using a hybrid deductive/inductive approach to identify barriers and facilitators as experienced by frontline staff involved in implementation.
Results: The key emergent themes highlight the significance of local context, processes, leadership, and resources as fundamental to implementation and sustainable delivery of RuralKidsGPS. A strong commitment of the nurse coordinators to optimise care quality, experiences, and equity of access for families with CMC was a central theme. However, this came at some cost to staff including stress about limited capacity of the model. Resourcefulness, local knowledge, and ability to leverage local resources and networks within health, social care, and disability systems, enabled delivery of family-centred care across diverse socio-economic and cultural backgrounds. But the timely implementation and delivery of RuralKidsGPS care coordination has been impacted by limited sharing of healthcare information across jurisdictions, recent natural disasters (widespread floods) and changes of key staff involved in the implementation. Support and leadership from local healthcare managers and professionals, enabled nurse coordinators to adapt and implement RuralKidsGPS. However, staff involved in the implementation, flagged concerns about managing service demand considering psychosocial and medical complexity, ensuring adequate service resourcing, streamlining workflows, and empowering families to navigate healthcare as significant challenges, whilst recognising that these factors are crucial for model adoption and sustainability.
Conclusion: Findings emphasise the significance of adapting integrated models of care to local contexts, and the importance of building trusting relationships to enable team-based interdisciplinary care coordination for CMC. Building capacity of families to navigate complex health care systems and to enable self-care where possible are crucial for the management of demand on the service. Ongoing implementation evaluation guided by the CFIR will further elucidate barriers and enablers of adoption and sustainability in the longer term.

Disclosure of Interest: None Declared

Keywords: integrated care, paediatric care coordination, rural