BackgroundChildren with complex needs can face barriers to system access and navigation related to their need for multiple services and healthcare providers. Central intake for pediatric rehabilitation was developed and implemented in 2008 in Winnipeg Manitoba Canada as a means to enhance service coordination and access for children and their families. This study evaluates the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example.MethodsA mixed methods instrumental case study design was used. Interviews were completed with 9 individuals. Data was transcribed and analyzed for themes. Quantitative data (wait times, referral volume and caregiver satisfaction) was collected for children referred to physiotherapy with complex needs (n = 1399), and a comparison group of children referred for orthopedic concerns (n = 3901). Wait times were analyzed using the Kruskal-Wallis test, caregiver satisfaction was analyzed using Fisher exact test and change point modeling was applied to examine referral volume over the study period.ResultsInterview participants described central intake implementation as creating more streamlined processes. Factors that facilitated successful implementation included 1) agreement among stakeholders, 2) hiring of a central intake coordinator, 3) a financial commitment from the government and 4) leadership at the individual and organization level. Mean (sd) wait times improved for children with complex needs (12.3(13.1) to 8.0(6.9) days from referral to contact with family, p < 0.0001; 29.8(17.9) to 24.3(17.0) days from referral to appointment, p < 0.0001) while referral volumes remained consistent. A small but significant increase in wait times was observed for the comparison group (9.6(8.6) to 10.1(6.6) days from referral to contact with family, p < 0.001; 20.4(14.3) to 22.1(13.1) days from referral to appointment, p < 0.0001), accompanied by an increasing referral volume for this group. Caregiver satisfaction remained high throughout the process (p = 0.48).ConclusionsCentral intake implementation achieved the intended outcomes of streamlining processes and improving transparency and access to pediatric physiotherapy (i.e., decreasing wait times) for families of children with complex needs. Future research is needed to build on this single discipline case study approach to examine changes in wait times, therapy coordination and stakeholder satisfaction within the context of continuing improvements for pediatric therapy services within the province.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1700-3) contains supplementary material, which is available to authorized users.

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G. Ernest Wright has argued in "The Lawsuit of God: A Form-Critical Study of Deuteronomy 32" that the genre of the Song of Moses is that of a "covenant lawsuit" or rîb. 1 This argument has been highly influential in subsequent research on the Song and is almost taken for granted by many now. 2 But not all have followed Wright's analysis. A number of criticisms have been leveled, and it has instead been argued that the Song belongs to the sphere of wisdom literature. 3 In this article, I will examine Wright's analysis of the Song, which I find wanting in regard to a number of features in the Song. I will show that the designation "covenant lawsuit" is only a partial description of the form and function of the Song, and I will argue that the Song evinces qualities of a number of different forms but that it broadly fits the category of a hymn. After demonstrating the hymnic elements that are found in the Song, I will conclude with some comments regarding the implications of these findings for the study of the Song.

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