Children with complex chronic conditions (CCC) receive care from diverse medical, educational and social service providers through various agencies for a prolonged period of time. Coordination of care between agencies serving these children is lacking, resulting in gaps and inefficiencies in care. Developing systems of coordinated care for children with special needs in communities is a Healthy People 2010 Objective. To develop systems of coordinated care we need information on how agencies providing care to children with CCC collaborate with one another. We propose to evaluate the existing system of coordinated care among agencies that serve children with CCC in Forsyth County, NC using an innovative methodology called social network analysis. The Specific Aims are: (1) to evaluate the extent of collaborative relationships that currently exist among agencies that serve children with CCC, (2) to identify agency-level factors and communication linkages that improve collaborative relationships with other agencies, and (3) to test, using longitudinal observational data, whether participating in a community coalition that focuses on improving care of children with CCC increases collaborative relationships with other agencies. We will analyze survey data from agencies using social network analytical techniques. The dependent measure is the 'tie of collaborative relationship'between one agency and another within the collaboration network for CCC. First, we will describe the collaboration network. Next, we will evaluate agency-level factors that improve collaborative relationships, with a focus on the presence of a care coordinator and communication linkages. Finally, we will assess effectiveness of community coalition in improving collaborative relationships at one year compared to baseline. The results of this study will enhance our understanding of the existing system of coordinated care for CCC and identify factors that improve such care. Results of this study will be used to design interventions to improve care coordination for children with CCC. In addition, this study will provide empirical evidence for effectiveness of community coalitions in improving collaboration between agencies and advance the science of evaluation of the health-care system. PUBLIC HEALTH RELEVANCE: This proposal addresses the issue of care coordination for children with complex chronic conditions, which is an important public health problem in the U.S. The results of this project will enhance our understanding of the existing system of coordinated care for children with CCC and help identify factors that foster collaborative relationships between agencies serving these children. Results of this study will be used to design interventions to improve care coordination for children with CCC.

R21HD061793

2009-09-01

2012-08-31