Understanding Coordinated Care for Children with Complex Chronic Conditions

描述（由申请人提供）：患有复杂慢性疾病（CCC）的儿童通过各种机构接受各种医疗、教育和社会服务提供者的长期照顾。服务这些儿童的机构之间缺乏护理协调，造成护理方面的差距和效率低下。为社区有特殊需要的儿童发展协调保健系统是2010年健康人目标。为了建立协调护理系统，我们需要了解为患有慢性脊髓炎的儿童提供护理的机构如何相互合作的信息。我们建议使用一种称为社会网络分析的创新方法来评估北卡罗来纳州福赛斯县为患有CCC的儿童提供服务的机构之间现有的协调护理系统。具体目标是：(1)评估目前服务CCC儿童的机构之间存在的合作关系的程度，(2)确定机构层面的因素和沟通联系，改善与其他机构的合作关系，(3)使用纵向观察数据测试，参与一个以改善CCC儿童护理为重点的社区联盟是否会增加与其他机构的合作关系。我们将使用社会网络分析技术分析来自机构的调查数据。依赖度量是CCC协作网络中一个机构与另一个机构之间的“协作关系纽带”。首先，我们将描述协作网络。接下来，我们将评估改善协作关系的机构级因素，重点关注护理协调员的存在和沟通联系。最后，与基线相比，我们将评估社区联盟在改善一年合作关系方面的有效性。本研究的结果将增进我们对现有CCC协调照护系统的了解，并找出改善这种照护的因素。本研究结果将用于设计干预措施，以改善儿童的照顾协调。此外，本研究将为社区联盟在改善机构间合作方面的有效性提供经验证据，并推动卫生保健系统评估科学的发展。公共卫生相关性：该提案解决了对患有复杂慢性疾病的儿童的护理协调问题，这是美国一个重要的公共卫生问题。该项目的结果将增强我们对患有慢性疾病儿童的现有协调护理系统的理解，并有助于确定促进服务这些儿童的机构之间合作关系的因素。本研究结果将用于设计干预措施，以改善儿童的照顾协调。

DESCRIPTION (provided by applicant): 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.