Process evaluation of a hub-and-spoke model to deliver coordinated care for children with medical complexity across Ontario: facilitators, barriers and lessons learned

Jia Lu Lilian Lin, Samantha Quartarone, Nasra Aidarus, Carol Y. Chan, Jackie Hubbert, Julia Orkin, Nora Fayed, Nathalie Major, Joanna Soscia, Audrey Lim, Simon D. French, Myla E. Moretti, Eyal Cohen

    Research output: Contribution to journalReview articlepeer-review

    8 Citations (Scopus)

    Abstract

    Background: Complex Care for Kids Ontario (CCKO) is a multi-year strategy aimed at expanding a hub-and-spoke model to deliver coordinated care for children with medical complexity (CMC) across Ontario.

    Objective: This paper aims to identify the facilitators, barriers and lessons learned from the implementation of the Ontario CCKO strategy.

    Method: Alongside an outcome evaluation of the CCKO strategy, we conducted a process evaluation to understand the implementation context, process and mechanisms. Semi-structured interviews were conducted with 38 healthcare leaders, clinicians and support staff from four regions involved in CCKO care delivery and/or governance.

    Results: Facilitators to CCKO implementation were sustained engagement of system-wide stakeholders, inter-organizational partnerships, knowledge sharing and family engagement. Barriers to CCKO implementation were resources and funding, fragmentation of care, aligning perspectives between providers and clinical staff recruitment and retention.

    Conclusion: A flexible approach is required to implement a complex, multi-centre policy strategy. Other jurisdictions considering such a model of care delivery would benefit from attention to contextual variations in implementation setting, building cross-sector engagement and buy-in, and offering continuous support for modifications to the intervention as and when required.

    Original languageEnglish
    Pages (from-to)104-122
    Number of pages19
    JournalHealthcare Policy
    Volume17
    Issue number1
    DOIs
    Publication statusPublished - Aug 2021

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