A qualitative study of care coordination in community physical rehabilitation

Abstract

Introduction

This study explored the factors influencing effective care coordination in a community physical rehabilitation service. The two research questions answered were “What was effective care coordination?” and “What were the barriers and enablers?”

Methods

This qualitative study, influenced by an interprofessional skill framework, was conducted in a regional service in Australia. Participants were 35 allied health, nursing, and client administration team members. Individual interviews, group observations, and focus groups generated data. This article will present the descriptive thematic analysis method and results.

Results

Care coordination resulted from a suite of informal and formal tools that smoothed the client’s rehabilitation journey. Effectiveness and efficiency were sought alongside client-centred, holistic, and flexible yet consistent approaches to care coordination. All staff undertook care coordination relevant to their managerial, clinical, or administration support roles. The involvement of many people and processes required effective teamwork, notably communication, collaboration, coordination, and navigation of stakeholder differences. The barriers to and enablers of care coordination were the service’s resources including integrated workspaces, transport and communication systems, and the individuals’ resources including clinical reasoning skills in, and familiarity and buy in with care coordination and rehabilitation.

Discussion

Staff viewed care coordination as an integral and valued part of rehabilitation, with some responsibilities shared by all staff. Additional time and support were required for stakeholders to enact their assigned care coordination roles. Effective care coordination required staff to be trained and competent in interprofessional collaboration. Systems that were efficient to use and encouraged accountability were desired.

Keywords

Community health services rehabilitation patient care communication coordination multidisciplinary teamwork

Introduction

In 2015, nearly two million adults with physical disabilities used health services whilst living in the Australian community.¹ To effectively and efficiently meet the needs of this population, services must offer a client-centred and integrated continuum of care, evidence-based practice, and earlier discharge from hospital with resultant increased duration in community care.² In community physical rehabilitation, effective and efficient care also requires an interprofessional approach, care coordination, equitable access, and early goal-directed intervention in an appropriate setting.³ This paper will focus on care coordination, investigating its use in meeting the needs of Australian adults with physical disabilities, for an efficient and effective interprofessional community rehabilitation service.

Care coordination is “the deliberate organisation of patient care activities between two or more participants, including the patient, involved in a patient’s care to facilitate the appropriate delivery of health care services.”⁴ Its role is to reduce healthcare use, increase health outcomes, and improve stakeholder satisfaction.⁵ Despite the importance of this role, adults with physical disabilities have complex needs that are not easily met using a standardized model of care coordination. Barriers to coordinated care include clients having multiple comorbidities alongside emotional and socioeconomic issues. Hence, multiple segregated services are often involved in their care. Limited expertise and availability of informal carers and health care services can also diminish care coordination effectiveness.^6,7

Looking to systematic reviews of effective care coordination models, services have used case management, integrated care, client-directed care, and client-centred care with community-dwelling older adults.^5,8 These models varied in their ability to improve client satisfaction, clinical outcomes and outpatient care use, and decrease inpatient care use and costs.⁸ Frequently, factors such as trusting team relationships, provider commitment to the model, strong governance, and sufficient time and flexibility have driven success in integrated care models.⁵ A systematic review of care coordination models for community-dwelling people with mental, cognitive or physical disabilities also found similar variation in the models and their ability to support independent living.⁹ Consequently, further research was requested on care coordination for people with disabilities, specifying that the context, interventions, and outcomes all require documentation.

Few contemporary studies exist on care coordination for adults with physical disability receiving interprofessional community rehabilitation. Healthcare providers for Veterans with traumatic brain injury in the United States of America felt regular communication, a collaborative interprofessional team, support and education for clients and caregivers, flexible scheduling, and personalised case management were most important for care coordination.⁷ To see if these findings translated to Australian government-funded community rehabilitation services, further research was still required. This qualitative study aimed to diminish that gap.

The first aim of this study was to ascertain the effective elements of care coordination in an Australian community physical rehabilitation setting, namely the valued outcomes, theoretical approaches, and practical tools of care coordination. A second aim was to determine any underlying contextual factors in the form of barriers or enablers, likely to create variable outcomes in practice. Thus, the two research questions were:

What was effective care coordination in community rehabilitation?

What were the barriers to and enablers of effective care coordination?

Methods

Design

Canada’s interprofessional collaboration competency¹⁰ framework was chosen to guide this study because of the dominant social interaction thread within care coordination literature.^6,11 Competent interprofessional collaboration is “a partnership between a team of health providers and a client in a participatory, collaborative and coordinated approach to shared decision making around health and social issues.”¹⁰ This practice framework influenced data collection and analysis themes, whilst the choice of qualitative design permitted additional themes to arise and be explored in depth. A qualitative design also highlighted the variability in how the community rehabilitation team experienced and influenced care coordination effectiveness, barriers, and enablers.

Setting

A state government-funded adult service in regional Australia was selected as the study site, with access granted by the service and business managers. The population was the interprofessional team trialling new care coordination tools (Table 1) for a more collaborative approach during their clients’ rehabilitation. This qualitative research study purposefully coincided with the first 11 months of the quality improvement project implementation (2016–2017).

Table 1.

New care coordination tools.

Stage	Tools
Assessment	Interprofessional referral intake process included phoning the client to determine readiness to attend. Coordinated scheduling of two to three appointments for clients using an electronic diary system (Outlook) displaying staff availability. Two smaller clinical teams were formed using similar days of working. Only members of that team saw the client.
Goal setting	Client-nominated goals were used to form an integrated rehabilitation plan within two weeks of the client starting.
Intervention	One clinician seeing each client was allocated a key worker role to manage the client’s rehabilitation.Interprofessional offices for each clinical team to increase informal communication opportunities.A visual display board in each clinical team’s office showed key dates, processes and clinicians involved in each client’s care. This was reviewed each week via a team meeting (huddle).
Evaluation	Interprofessional case conferences used the new rehabilitation plan format to guide integrated goal-based discussion, rather than individual disciplines reporting their own separate actions. Patient-specific outcome measure (PSOM) was used: Client rating of goals pre- and post-intervention. Regular rehabilitation plan review with clients was encouraged, with an interim summary sent to stakeholders (GP, referrer, client) every six weeks.
Discharge	New discharge summary template completed by clinicians within two weeks of discharge. Summaries focussed on outcomes and handover of ongoing care instead of interventions completed, as requested by GPs.

GP: General Practitioner.

Recruitment

After ethics approval (Tasmanian Health and Medical Human Research Ethics Committee, University of Tasmania, H0015468), recruitment targeted a purposive sample with a diversity of opinions and experiences regarding care coordination and change processes. Confidential emails and conversations with all potential participants facilitated a response and ensured written informed consent.

Participants

All service employees were eligible to participate. Recruitment to the purposeful sample stopped after 13 key participants (Table 2), as this number was deemed feasible to follow in the allocated time. Four employees from two unrepresented professions were approached, but they decided not to proceed due to perceived restrictions in available work time. One junior employee from another profession withdrew after the initial interview for the same reason. Accordingly, representation by some professional and by junior employees was limited in the purposive sample. The convenience sample of 22 additional participants was recruited from focus groups and group observations, and represented all professions and responsibility levels.

Table 2.

Demographics.

Element	Purposeful sample, n=13	Convenience sample, n=22
Profession	Occupational therapist (3), nurse (2), social worker (2), speech pathologist (1), physiotherapist (1), client service officer (1), allied health assistant (1), other (2)	Occupational therapist (4), nurse (2), speech pathologist (1), physiotherapist (8), client service officer (2), allied health assistant (2), psychologist (1), doctor (1), client (1)
Responsibility level#	Manager (2), senior (7), junior (4)	Manager (1), senior (9), junior (12)
Age (years)	Range 30–65, median 42	Data not collected
Full time equivalence (FTE)	Range 0.3–1, median 0.8
Years at service	Range 0.25–14, median 7
Years in profession	Range 1.5–34, median 19

Researchers

The University research funding criteria and budget meant the three female researchers were part time clinicians at the study site, who worked voluntarily on a workplace research topic whilst developing research skills. The lead researcher designed and implemented the study, with the other two researchers completing data collection and analysis for two participants and a focus group each. At the beginning of the study, the team members were between 42 and 60 years of age, had been at the service for 12 to 15 years, and worked 18 to 40 years in nursing, physiotherapy, or occupational therapy. To minimize the impact of biases on data, researchers employed five trustworthiness techniques of triangulation, peer review, member checking, rich description, and reflexive memos.¹² The research design was approved by the University and rehabilitation service supervisors.

Data collection

Data collection tools were piloted amongst the research team to refine researcher technique and data collection guides (Supplementary file 1). The purposeful sample attended two individual interviews, and both sample groups attended focus groups and were observed during care coordination interventions. This combination of tools enabled perceptions and social interactions to be triangulated, with a rich description of context formed. Researcher and participants’ interactions were tape recorded and transcribed clean verbatim, with non-verbals also documented. Researchers clarified phrase meaning and non-verbals during follow-up interviews. Each follow-up interview guide was unique, tailored to that participant’s earlier data and topics evolving from the pooled data analysis. A total of 10 group observations (8 h), 27 individual interviews (16 h), and two focus groups (1.5 h) were conducted at the rehabilitation service.

Analysis

De-identified files were securely stored and coded using the qualitative software program Nvivo 11 Pro.¹³ To ensure coding consistency, the first three participants’ data were coded by researchers together. During subsequent coding, the research team listed and defined new codes on Nvivo as they arose. This ensured that the evolving list of codes was always accessible to the team. This inductive method of coding maintained the breadth of data available for final descriptive thematic analysis. Ninety-six codes were reviewed by the lead author for inconsistencies, duplications, and connections,¹⁴ then organised into 15 themes. Although interprofessional collaboration featured strongly in the data, a new framework (Supplementary file 2) was developed to encompass the additional themes that did not fit Canada’s interprofessional collaboration competency¹⁰ framework. To prevent misrepresentation, participants reviewed and agreed to their contributions to each theme.

Results

Data analysis identified the four major descriptive themes of outcomes, teamwork, approaches and availability of resources, with two or three sub themes under each (Figure 1). Each major theme provided the foundation for the theme above. “What was effective care coordination in community rehabilitation?” was answered by the three themes outcomes, approaches and teamwork. “What were the barriers to and enablers of effective care coordination?” was answered by the major theme of availability of resources.

Figure 1.

Hierarchical framework of findings – major themes and subthemes.

What was effective care coordination in community rehabilitation?

Outcomes

Participants described the outcome of care coordination as effectively and efficiently smoothing the client’s rehabilitation journey. Effective care coordination supported the client’s satisfaction with interventions and a faster reintegration into a changed life. Care coordination tools minimised duplication and fragmentation amongst multiple stakeholders. Efficient care coordination focussed the therapy direction and managed the client’s rehabilitation enablers and barriers.

I guess communication between the client and all the team members, so that everyone is on the same page and knows what they are working towards. It is also trying to be client focused which means logistical stuff like trying to make it work for the client in terms of where it's best to do the rehab, keeping all the appointments together. The team being organised to limit the barriers to the client accessing the rehab or achieving what they want to do. (Interview – Participant (P) 8, clinician)

Participants discussed balancing clients’ needs with the service’s needs to ensure both efficiency and engagement. There was a tipping point in client outcomes, where quality was affected if the focus was excessively on efficiency.

I agree there is a lot of pressure now on reducing length of episodes. Yet there are many occasions when we just need to spend more time with clients. You've got to treat them and they're complicated. You're not necessarily doing a bad job because you have had clients on your books for a long time. (Focus Group 2 – P28, clinician)

Approaches

Effective care coordination required holistic client-centred care as well as consistency and flexibility in approach. Participants described client-centred care as the client feeling that their needs were accommodated.

Client centred care means to me the baseline of our work, it is like a litmus test. Looking at the person, their needs, and their personality, and measuring this against the health system as an organisational structure; and fairness, non-judgmental rights of the person all pertain to this kind of aspect. One needs to see if the decision is made in the client's best interests, or just convenience, prejudice, or out of our field of care. (Interview – P6, clinician)

Good client outcomes required knowing the frame of mind and abilities of each client, and providing relevant intervention. Client-centred care was an ongoing process and required reflection as to how clinicians may be directing therapy in an undesired direction. To counteract this possibility, other participants described that part of their role was to assist the client’s voice to be heard in the negotiations with other clinicians.

For holistic care, an awareness of the interaction of all areas of the client’s life, impairments, and supports was deemed important. An appreciation of the whole person was achieved either individually or via teamwork.

You can be a holistic sole practitioner and you may see a pretty good holistic picture of a client, but it is still from your perspective. With an inter-disciplinary team, you bring all your holistic perspectives together and you have a mega puzzle with a much more varied and richer picture of the client. It can also help if staff aren’t quite so holistic, it helps to fill in the gaps, doesn't it? The team – you get the benefits of multiple brains working together, multiple views and multiple relationships with that client. (Interview – P12, manager)

Participants wanted both consistency and flexibility in the care coordination approach. System structures and processes as well as social interactions facilitated an understanding of requirements, which in turn reduced staff confusion. However, participants felt the system did not always encourage consistency or accountability, and needed further management.

We have so many DNAs (clients who did not attend) who make care co-ordination clunky and time consuming. This is echoed in every single outpatient centre all around the world, so it is not one that we have in isolation. How has that evolved? Parts of that are access to transport, financial strain, and the high number of neuro clients that we see here, as opposed to orthopaedic. Part of it is the value that clients place on our service as well. I am interested in how you increase the perceived value of our service for the clients, and for me, that is in saying, “Okay here is your rehab plan, we are going to have ten sessions, now if you don't attend five of those, then you will only have five sessions”, but because we haven't got a stance (policy) on that it is different for everyone who walks through the door. So, there are flow-on effects which I still think we are not that great at seeing. (Interview – P3, clinician)

One participant reported that it was impossible to be consistent in their approach, yet simultaneously accommodate the unique, and at times, unexpected aspects of complex clients. Flexibility ensured a personalised client care plan. A flexible approach was also required when service capacity or demand changed.

There are challenges still with balancing caseloads across individuals and teams. It impacts on the coordination experienced by clients due to this variation in capacity to pick up across disciplines. Our capacity fluctuates with leave, the number of single discipline clients and the number of overall clients per discipline. (Focus Group 1 – P16, clinician)

Teamwork

Effective care coordination required communication about logistics and clinical reasoning for client’s rehabilitation. Information exchange occurred when investigating client’s needs, justifying decisions, and educating others. Participants defined effective communication as respectful, timely, and clear. Alternatively, ineffective communication involved inaccurate information, which created confusion and insecurity, and wasted time.

Things that make it harder are say if someone is on leave, well this week it's [a clinician] on sick leave. She called and said she has a list for five or six clients today, not one of them has managed to make it onto [the electronic client appointments record]. They (clients) are already ringing me up, saying “Do I have an appointment today?” and I'm thinking I don't know. I don’t have access to her [electronic] diary so I have no clue, and then [her manager] is not here today either (to follow up). (Interview – P1, support staff)

Participants advised that effective care coordination reduced the time clients and carers spent away from their normal lives and accelerated client outcomes via interprofessional interventions. Coordinated care synchronized client goals and home programmes across rehabilitation professions, and avoided overwhelming the client with multiple demands. The time it took to coordinate between the different parties was extensive, especially because of the many part time staff, and the number of community services that clients accessed simultaneously. Due to the complexity of navigating the health system, participants were divided upon whether coordination was best done by the service for efficiency or by the client for empowerment.

Collaboration required time and skill to generate a mutually agreed client care plan. This created a better outcome for individual clients, a synergy rather than simply an amalgamation of individual stakeholder interpretations and actions. At an organisational level, the synergy between several services enabled client or community needs to be met.

I had a complex person with a spinal cord injury and we had to get housing, health, disability services, and carer organisations all together to manage this person's transition from hospital to community. That was the only way it was going to happen because health couldn't discharge the person on their own. It was going to take more resources and sharing of costs than a clinician could actually have the power to make happen. That to me was a good example of high level complex care co-ordination. We worked together to successfully help the person exit hospital, and they (the person’s family) were part of some of the meetings as well. (Interview – P12, manager)

Effective care coordination required stakeholder differences to be accommodated. Participants assigned these differences a negative, neutral, or positive connotation, depending on their impact on teamwork. Positive connotations arose when differences such as stakeholders’ life experiences, staff roles, or service models were perceived as complementary and enabled wholistic client care. Alternatively, negative connotations arose when differences caused conflict in interactions and hampered client care. Examples here included differences in individual personality or priorities for time, staff approaches to teamwork or client-centred care, or service administration processes. Participants advised that in these situations it was difficult to understand the rationale for the stakeholder’s opposite behaviours and perspectives. When no common understanding could be achieved, working around rather than trying to negotiate the differences made teamwork tolerable, but the negative perceptions remained.

Differences in services were perceived neutrally if services were seen to be appropriately catering for different client needs or service philosophies.

… sometimes it is the clash between a medical model and a bio-psycho social model, … people are using a philosophy they believe is true and that they work by. …rather than understanding and appreciating that there are different models that need to be there. The demands of, like a hospital can't work on a bio-psycho social model very easily can it, it is going to be a medical model; but then you come to us (community rehab) and we work differently and that is okay. … I had to explain (to others) that the way we work is valid, and (just) because we don't work the same as you, this doesn't mean that we are bad. (Interview – P12, manager)

Clients’ differences in needs, goals, and episode length were also perceived neutrally by participants. Participants explained that client diversity added complexity, but that this was normal in a regional rehabilitation service. Likewise, diversity amongst part time staff regarding their differing days of work was accepted as integral to a family-friendly workplace, despite communication being more difficult as a result.

What were the barriers to and enablers of effective care coordination?

Availability of resources

The major theme “availability of resources” was used to explore barriers to and enablers of effective care coordination. Resources were a barrier if absent or enabler if present in social interactions. Human resources played a key part in care coordination. Familiarity with rehabilitation stakeholders meant that participants were able to carry out care coordination effectively and efficiently. Staff knowledge was a resource that covered several different aspects about the clients, health professional staff, and health system (Table 3). This knowledge enabled participants to educate new staff members, make appropriate referrals, and integrate client care for a better outcome.

Table 3.

Staff knowledge required about clients, health professionals, and health system.

Aspect	Examples of required knowledge
Client	Rate of recovery, understanding of intervention, social situation, cognitive capacities, services used, holistic health needs, goals.
Health professionals	Roles and associated tasks, capabilities and preferred ways of working, staffing patterns, expectations placed on themselves by others. Clinical knowledge required for teamwork and rehabilitation planning.
Health system	Newly introduced care coordination processes, practical resources across the organisation, eligibility criteria and waitlist for different services, strategic direction for rehabilitation.

Likewise, knowledge by external services on how the study setting operated was essential for maintaining positive relationships between services. Stability of stakeholders enabled familiarity, where as a dynamic environment required continual communication and adjustment of expectations.

Staff incorporated this knowledge with their clinical reasoning skills to develop realistic rehabilitation plans with clients. Clinical reasoning skills, as a resource present within experienced staff, also enabled respectful interprofessional communication. It helped staff understand each other’s perspectives when problem solving or justifying care provision.

I have had some great conversations with GPs (General Practitioners) lately that have had good outcomes for clients, but it doesn't always work out that well. So, it is nice if you can get someone on the other end of the phone who respects that you have been working with the client and your clinical decision making. You might be requesting a referral while letting them know about something, and they take that seriously and make some time in their busy schedules to hear you and follow it up. (Interview – P13, clinician)

Achievement of care coordination required both client and staff commitment or buy in. One participant suggested buy in generated better staff accountability, and hence client satisfaction and empowerment. Effective and committed partnerships were enabled by friendly staff, likeable clients, and a perception of equality. A barrier was conflicting commitments for available staff time.

I am sort of working at a system with the huddles (clinical team meetings), so on Fridays I see who is on which list and then work out which huddle to attend, the one that I don't go to, if there is anything to contribute to that huddle, a few minutes before the meeting, I hand over a little written summary to the leader of that team with an explanation. (Interview – P7, clinician)

As well as human resources, barriers and enablers also incorporated service facilities, namely space, transport, and communication tools. One participant reported limited confidential working space for discussions with clients, whilst another noted that the interprofessional offices supported informal group conversations about clients. A wheelchair-accessible bus and taxi funding subsidised client’s costs to attend rehabilitation appointments. Cars available for client home assessment helped staff observe clients in their own environments and identify functional goals.

Coordinating care with busy, part time staff over two buildings demanded use of accessible communication tools such as the existing electronic health record and email. Valued communication tools used with clients were use of a key worker, comprehensive initial assessment, interprofessional care plan, and ongoing face-to-face reviews. A central interprofessional referral and intake system as a communication tool was also an enabler, but it was not always used by clinicians.

I find it really frustrating with the number of access points to our service. So, (for example) from somewhere like [a hospital] we have a lot of OT (Occupational Therapy) to OT direct communication that often happens before a client is referred, and it is almost like the outcome of the referral has been pre-determined before the intake team has had a chance to have a look at it, which just then leads to rumours …. So, where I can, I have tried to make sure that the co-ordinators at [the hospitals] are always the access point for communication, and that it is only once we know that we will be involved, that we start the flood gates of clinician to clinician communication. (Interview – P3, clinician)

Communication tools within new care coordination interventions (Table 1) took extra time to learn, but participants and researchers noted they all enabled teamwork. Weekly team meetings and client review meetings were valuable structures because the allocated time was a reoccurring event, all staff attended, and staff could seek advice from any team member. Looking to the future, several participants strongly recommended a central system to coordinate appointments. Participants also requested a refined rehabilitation planning process that accommodated clients with reduced cognition, health literacy, or assertiveness. These remained as barriers during the early implementation stage.

Discussion and conclusion

Care coordination outcomes and approaches at the study site mirrored Australian rehabilitation best practice.^2,3 Effective care coordination progressed clients efficiently through the service, integrated holistic care, directed care using evidence-based practice guidelines, and obtained client input into rehabilitation planning. It appeared that the new practical care coordination tools were the glue that brought together the client and different professions, and enabled a mutual understanding of rehabilitation. The service studied was unique, as care coordination was an integral expectation of all rehabilitation staff. The experiences of managers and support staff, previously unrepresented in the care co-ordination literature, were explored alongside those previously researched, namely clients and nursing and allied health staff. The study therefore facilitated a better understanding of and advocacy for the variety of care coordination roles done by interprofessional colleagues and clients within rehabilitation. Care coordination roles in the literature included assessor, planner, educator, facilitator, and monitor.¹⁵ Whilst no new roles were identified in this study, considerable variation existed within the roles, relative to the scope of the participant’s position and the perceived resources available to do it. Interaction with colleagues also influenced the perception and evolution of care coordination roles.¹⁶

As in the literature, teamwork was essential for effective care coordination in interprofessional rehabilitation.⁷ In this study, participants’ satisfaction with care coordination was often determined by opportunities for teamwork, and positive or negative perceptions of clients’ or colleagues’ care coordination behaviours. Past qualitative studies also identified the presence of this synergy in rehabilitation settings.¹⁷

The human and non-human barriers to and facilitators of care coordination provided the context associated with the above outcomes. The literature supported the findings regarding the influence of stakeholders’ attitudes, skills, and knowledge in working across professional or organisational boundaries.^11,17 Communication gaps due to inefficient systems or lack of integration⁶ were also present in this study. Whilst participants did not discuss financial considerations, time restraint⁵ was confirmed as a barrier to care coordination.

Methodologically, confirmatory relationships were present between this study and past studies’ findings, and amongst all participants (sources), giving weight to the trustworthiness of findings.¹² These strengths make the study attractive to rehabilitation colleagues experiencing the same situation and looking for new insights.

Contributions to research were influenced by sampling constraints. There was difficulty recruiting some professions and junior staff involved in rehabilitation to the already small study sample. This may have meant valuable perspectives from busy clinicians, those learning about care coordination and teamwork, and those disinterested in care coordination were not represented. Focus groups generated a limited amount of data, being constrained by the sample’s scheduled work commitments. Further planning and buy in may have resolved these issues.

Researcher biases potentially influenced findings so are reported here for transparency. They are past experiences with clients, care coordination tools, and teamwork; professional values and roles; understanding of other disciplines and services; and personal preferences of ways of working. Findings were also possibly influenced by the fact that researchers were colleagues of the study population. Participants may have responded more enthusiastically about care coordination or left out negative perspectives, to be seen positively by researchers.

The enablers of care coordination should be implemented and encouraged by community rehabilitation services. The barriers to care coordination still require systemic removal. Practical recommendations include individual change, group conversations and supporting systems to clarify, and enforce care coordination roles and responsibilities. Individual accountability and time for effective care coordination of existing clients as well as starting rehabilitation interventions with new clients could be facilitated by manipulating wait lists, team expectations, and staffing levels. The domination of teamwork as a theme means that opportunities to interact with other rehabilitation professions and develop interprofessional competency¹⁸ are important for improved care coordination. Mentors and team projects to support the development of these interprofessional skills are also required so that relationships, as well as the clinical processes, are mutually improved.¹⁹ Lastly, supporting systems and processes for local care coordination need refining to increase the ease of communication amongst team members. This includes removing multiple access points for information and achieving consensus on how to use the communication tools. These recommendations all require organisational commitment for them to be implemented.

Given the international consumer-driven care mandate, researching client satisfaction with care coordination tools in community rehabilitation is recommended. Future research could also focus on strategies to empower clients to do their own care coordination, given that they appear aware of the processes required, and that it may be easier without clinicians being the messenger in the middle.²⁰ Finally, the available local workplace data on compliance with care coordination tools, resultant overall costs across the organisation, and client outcomes also require analysis.

This article explores staff perceptions of and actions within care coordination in community rehabilitation in regional Australia. A significant finding was the importance of teamwork in determining effectiveness of care coordination interventions. The barriers to and enablers of care coordination influenced teamwork, which then influenced the approaches and outcomes of care coordination. The dominance of interprofessional teamwork in the findings makes it a target area for improvement. This finding reflects findings in other healthcare literature and resonates with the local experience of staff and researchers.

Supplemental Material

ICP895418 Supplemental material - Supplemental material for A qualitative study of care coordination in community physical rehabilitation

Supplemental material, ICP895418 Supplemental material for A qualitative study of care coordination in community physical rehabilitation by Jane L Symons, Julie Jamison, Jane Dening, Linda Murray and Sue Pearson in International Journal of Care Coordination

Footnotes

Acknowledgements

Thanks to the participants who volunteered their experiences of care coordination, and to a volunteer Sue for transcribing them. Thanks to the anonymous journal reviewers for their feedback.

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Three researchers were existing clinicians at the study site. The raw data was accessible to only these authors.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jane L Symons

Supplemental material

Supplemental material for this article is available online.

References

Australian Bureau of Statistics. Disability, ageing and carers. Report no. 4430.0. Australia: Summary of Findings, 2015.

Tasmanian Health Organisation. Strategic plan 2013–2016. Tasmania: Tasmanian Health Organisation, 2013.

Hearn

Rehabilitation models of care: overview of literature review (Nov 2013). Victoria: Department of Health & Human Services, 2013.

McDonald

Sundaram

Bravata

, et al. Closing the quality gap: a critical analysis of quality improvement strategies: volume 7 – care coordination. Report no. Publication No. 04(07)-0051-7, 28 October 2015. Rockville, MD: Agency for Healthcare Research and Quality, 2007.

Kirst

Burns

TIM

, et al. What works in implementation of integrated care programs for older adults with complex needs? A realist review. Int J Qual Health Care 2017; 29: 612–624.

Braaf

Ameratunga

Christie

, et al. Care coordination experiences of people with traumatic brain injury and their family members in the 4-years after injury: a qualitative analysis. Brain Inj 2019; 33: 574–583.

Smith

Martinez

Evans

, et al. Barriers and strategies for coordinating care among veterans with traumatic brain injury: a mixed methods study of VA polytrauma care team members. Brain Inj 2018; 32: 755–762.

Low

L-F

Yap

Brodaty

A systematic review of different models of home and community care services for older persons. BMC Health Serv Res 2011; 11: 1–15.

Simon

Chen

, et al. Comparative effectiveness of care coordination for adults with disabilities. Washington, DC: Mathematica Policy Research, 2011.

10.

Canadian Interprofessional Health Collaborative. A national interprofessional competency framework. Vancouver, BC: Author, 2010.

11.

Johansson

Eklund

Gosman-Hedström

Multidisciplinary team, working with elderly persons living in the community: a systematic literature review. Scand J Occup Ther 2010; 17: 101–116.

12.

Lincoln

Guba

Naturalistic inquiry. Beverley Hills, CA: SAGE Publications, 1985.

13.

QSR International. Nvivo 11 for Windows ed. Melbourne: QSR International, 2016.

14.

Liamputtong

Research methods in health: foundations for evidence-based practice. 2nd ed. South Melbourne, Victoria, Australia: Oxford University Press, 2013.

15.

Lukersmith

Fernandez

Millington

, et al. The brain injury case management taxonomy (BICM-T): a classification of community-based case management interventions for a common language. Disabil Health J 2016; 9: 272–280.

16.

Symons

Jamison

Dening

, et al. Improving care coordination in community physical rehabilitation: A qualitative study of the change framework. Int J Care Coordination; 2019; 22: 140–147.

17.

Kraft

Blomberg

Hedman

A-M.

The health care professionals' perspectives of collaboration in rehabilitation – an interview study. Int J Older People Nurs 2014; 9: 209–216.

18.

Fougner

Horntvedt

Students' reflections on shadowing interprofessional teamwork: a Norwegian case study. J Interprof Care 2011; 25: 33–38.

19.

Cameron

Impermeable boundaries? Developments in professional and inter-professional practice. J Interprof Care 2011; 25: 53–58.

20.

Ruggiano

Shtompel

Edvardsson

Engaging in coordination of health and disability services as described by older adults: processes and influential factors. Gerontologist 2015; 55: 1015–1025.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.26 MB