Reorganizing pediatric rehabilitation services to improve accessibility: do we sacrifice quality?

Abstract

BackgroundThe impact of a pediatric rehabilitation service delivery reorganization to improve access to services on parents' and service providers' perception of service quality was evaluated. Child-, family-, service- and service provider-related characteristics possibly associated with these perceptions were explored.MethodsPerceptions were measured using the Measure of Processes of Care tools and open ended questions before (2007), during (2008) and following (2009) service reorganization. Child and family characteristics, services received and service provider data were documented. Mean MPOC scores were compared over time (ANOVAs and Generalized Estimating Equations) and t-tests, correlations and ANOVAs determined whether the characteristics influenced scores.ResultsFamilies' (n = 222) and service providers' (n = 129) perceptions of quality were high in 2007 (3.67 to 6.31/7) and remained high over the next 2 years (p ≥ 0.16). Two MPOC domain scores (Respectful care and Providing general information) were consistently scored the highest (mean ≥ 5.66/7) and the lowest (mean ≤ 4.75/7), respectively. Families with more education and those with children 12-21 years old tended to attribute lower MPOC scores. Participants were generally satisfied with the new service model and recommendations included improving information exchange.ConclusionsResults suggest that it is possible to reorganize pediatric rehabilitation services while maintaining quality.

Development, Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

“…First, the SWOT provided a clear portrait of the program's situation overtime and results showed that after the implementation of the model, clinicians felt an increase in service accessibility but worried about the possibility of not being able to tailor services according to children's needs (Camden, Swaine, Tétreault, & Carrière., 2011). Families' and clinicians' perceptions of the service quality measured by the MPOC indicated that despite the upheavals caused by the reorganization of services, the quality was maintained during the 3 years (Camden, Swaine, Tétreault, & Brodeur, 2010).…”

“…However, few models of rehabilitation service delivery are published; articles relate only to one health profession or to general models offering limited guidelines for service organization in pédiatrie rehabilitation. Others propose strategies (e.g., 30 min sessions rather than 60 min, changes in administrative procedures and increased group interventions) to reduce waiting times for children with disabilities (Clow et al, 2002;Miller et al, 2008), but these are more punctual solutions rather than global service reorganization strategies.…”

A Service Delivery Model for Children with DCD Based on Principles of Best Practice

“…Specifically for children with DCD, wait-times decreased following implementation from 214 days in 2007 to 63 in 2009, and the overall number of hours of services provided to each child (p=0.93) and the perception of service quality (p>0.15) remained stable over time (sub analysis reported in Camden et al, 2010). Parents of children with DCD reported appreciating 9 group interventions and the opportunities provided for their child to make friends and to learn new skills, even though some would have preferred access to more individual interventions (Camden et al, 2012).…”

“…Following implementation, the impact of the Apollo service delivery model on families of children with different diagnoses was evaluated and results revealed that service quality was maintained while the numbers of children receiving service increased and wait times decreased (Camden et al, 2010;Camden et al, 2013b) for all children in the Center, including children with DCD. Specifically for children with DCD, wait-times decreased following implementation from 214 days in 2007 to 63 in 2009, and the overall number of hours of services provided to each child (p=0.93) and the perception of service quality (p>0.15) remained stable over time (sub analysis reported in Camden et al, 2010).…”

“…The principles used to develop services for children with DCD (e.g., population-based interventions offered in partnership with the community) were used to develop a new service delivery model that would guide services for all children with disabilities in the Center. The development, implementation and evaluation of the new service delivery model, called Apollo, have been reported elsewhere (Camden et al, 2010;Camden et al, 2013a;Camden et al, 2009), but the way in which its implementation shaped the DCD program has never been described.…”