It’s About Time: Rapid Implementation of a Hub-and-Spoke Care Delivery Model for Tertiary-Integrated Complex Care Services in a Northern Ontario Community

Major, Nathalie; Rouleau, Marie; Krantz, Chantal; Morris, Karen; Séguin, François; Allard, Megan; Lin, Jia Lu Lilian; Salenieks, Mary Ellen; Sultan, Roxana; Smith, Wil

doi:10.12927/hcq.2018.25624

Cited by 5 publications

(7 citation statements)

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“…The CCKO strategy is based on a hub-and-spoke care delivery model for CMC, whereby each of the four tertiary paediatric hospitals ("hubs") in Ontario are responsible for both running an ambulatory complex care program within their centre and working collaboratively with care providers in the community to establish tertiary-integrated complex care clinics ("spokes") in different parts of their defined region ( Major et al 2018 ; Rosenbaum 2008 ). Northern Ontario is a dedicated region, which is a shared responsibility between the four regional hub sites.…”

Section: Background: Ccko Provincial Strategymentioning

confidence: 99%

Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned

Lin

Quartarone

Aidarus³

et al. 2021

hcpol

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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. Semistructured 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.

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Section: Background: Ccko Provincial Strategymentioning

confidence: 99%

Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned

Lin

Quartarone

Aidarus³

et al. 2021

hcpol

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“…13,[28][29][30] For example, because parents identified discontinuity between hospital admissions, hospital administrators and providers may consider the following: (1) creating inpatient complex care teams with core personnel who know families well, (2) creating inpatient consult services with early involvement of providers from outpatient medical homes, or (3) increasing visibility of and ease of access to the most vital information required for each patient's care within electronic health records. [31][32][33][34][35][36] Filling prescriptions and obtaining insurance coverage for refills were also problematic for families in our study; practitioners and administrators may consider developing systems to help families identify pharmacies that are capable of filling their prescriptions before discharge and longer-term services to support families and primary care physicians as they navigate complications with insurance coverage. Other challenges with longitudinal care, such as difficulty obtaining necessary resources as children age, would be best tackled through a multidisciplinary approach with the integration of social and medical services.…”

Section: Lack Of Inpatient Continuitymentioning

confidence: 92%

Parent Perspectives During Hospital Readmissions for Children With Medical Complexity: A Qualitative Study

Leary

Krcmar

Yoon

et al. 2020

Hospital Pediatrics

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Children with medical complexity (CMC) have high readmission rates, but relatively little is known from the parent perspective regarding care experiences surrounding and factors contributing to readmissions. We aimed to elicit parent perspectives on circumstances surrounding 30-day readmissions for CMC. METHODS:We conducted 20 semistructured interviews with parents of CMC experiencing an unplanned 30-day readmission at 1 academic medical center between December 2016 and January 2018, asking about topics such as previous discharge experiences, medical services and resources, and home environment and social support. Interviews were recorded, professionally transcribed, and analyzed thematically by using a modified grounded theory approach.RESULTS: Children ranged in age from 0 to 15 years, with neurologic complex chronic conditions being predominant (35%). Although the majority of parents did not identify any factors that they perceived to have contributed to readmission, themes emerged regarding challenges associated with chronicity of care and transitions of care that might influence readmissions, including frequency of hospital use, symptom confusion, lack of inpatient continuity, resources needed but not received, and difficulty filling prescriptions. CONCLUSIONS:Parents identified multiple challenges associated with chronicity of medical management and transitions of care for CMC. Future interventions aiming to improve continuity and communication between admissions, ensure that home services are provided when applicable and prescriptions are filled, and provide comprehensive support for families in both the short-and long-term may help improve patient and family experiences while potentially decreasing readmissions.

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“…This Environmental Scan identified 5 hub-and-spoke models that are implemented in Canada or internationally for delivering services for chronic non-pain indications. [26][27][28][29][30] These models are for pediatric patients with complex conditions, 26 spinal disorders in rural settings, 27 cancer, 29 and opioid use disorder. 28,30 The traditional hub-and-spoke model where the hub is a tertiary care centre that is linked with community care centres or regional hospitals (the spokes) Ottawa Hospital Pain Clinic 20…”

Section: Hub-and-spoke Model Of Care For Other Chronic (Non-pain) Medical Conditionsmentioning

confidence: 99%

“…• young adults is used by 2 of the identified models. 26,29 In these models, the hubs serve as the central coordinator for care. In the hub-and-spoke model for spinal disorders in rural settings, the model shifts the direction of the patient flow through the model, whereby patients receive lower-intensity care at the general hospital "spokes" and are referred to the tertiary care hub for more comprehensive care and follow-up.…”

Section: Hub-and-spoke Model Of Care For Other Chronic (Non-pain) Medical Conditionsmentioning

confidence: 99%

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Models of Care for Chronic Pain

Brett¹,

MacDougall²

2021

cjht

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For chronic pain, 1 hub-and-spoke model and 4 stepped care models for the delivery of care in Canada and internationally were identified and described. No information was found on the use of the Oncology Care Model for chronic pain. For other medical conditions, 9 stepped care models, 5 hub-and-spoke models, and the Oncology Care Model for the delivery of care in Canada and internationally were identified and described. Patient-related outcomes used to evaluate the effectiveness of models of care for chronic pain include pain measures (e.g., intensity, duration), psychosocial outcomes (e.g., anxiety, depression), functional outcomes (e.g., disability, employment status), and health care utilization (e.g., opioid prescriptions, health care visits). Various barriers and facilitators to providing care for patients with chronic pain were identified in the consultations and the literature. The most common factors that influenced the care provided to patients with chronic pain pertained to funding, support, and collaboration from the government and locally; having a centralized intake and referral system; and leveraging existing resources. There appears to be considerable variation in the models of care used to address the care needs of patients with chronic pain. In Canada, there are provincial, regional, and local models, and local programs; some regions do not have a formalized approach for the provision of care for chronic pain patients.

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It’s About Time: Rapid Implementation of a Hub-and-Spoke Care Delivery Model for Tertiary-Integrated Complex Care Services in a Northern Ontario Community

Cited by 5 publications

References 0 publications

Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned

Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned

Parent Perspectives During Hospital Readmissions for Children With Medical Complexity: A Qualitative Study

Models of Care for Chronic Pain

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