Work-Sampling Study of an Innovative Care Coordination Program Aimed at Children With Chronic Health Conditions.

PURPOSE OF STUDY: To estimate time allocation and labor cost for care coordinators (CCs), community health workers (CHWs), and mental health workers (MHWs) to conduct care coordination tasks in a pediatric care coordination program. PRIMARY PRACTICE SETTING: A public tertiary academic medical center in Chicago, IL. METHODOLOGY AND SAMPLE: A work-sampling study was conducted using a text message-based survey on 5 CCs, 20 CHWs, and 4 MHWs who volunteered to participate. Workers were randomly sampled within working hours to collect information on who was the subject of interaction and what service was being delivered over a 6-month period. Time allocation of workers to different subjects and services was summarized using descriptive statistics. RESULTS: Care coordinators allocated 41% of their time to managing CHW teams. Community health workers allocated 37% of time providing services directly to children and 26% to the parent/caregiver. Mental health workers allocated 16% of time providing services to children and 29% to the parent/caregiver. The care coordination program serviced 5,965 patients, with a total annual labor cost of $1,455,353. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Community health workers spent the majority of time working with patients and their families to conduct assessments. Mental health workers primarily addressed children's needs through their caregivers. Care coordinators primarily supported CHWs in coordinating care. Results may be used to inform development of such programs by determining services most often utilized, and labor cost may be used to inform program implementation and reimbursement.

Facilitators and Barriers to Implementing Transitional Care Managers Within a Public Health Care System.

Transitional care is crucial to ensure quality of care and safety for elderly patients. In the context of health care reforms promoting a shift from a hospital-centered approach to a home care approach, transitional care becomes a vital component and social workers can play an important role in easing transitions. Most recent studies have focused on the development or improvement of transitional care intervention models or tools, but few have addressed implementation issues. In this study, the implementation process of an innovative intervention aiming to integrate transitional care managers (TCMs) from Health and Social Services Centres (HSSC) within two Canadian hospitals was evaluated. Data collection comprised focus groups (n = 8), direct observations, meeting minutes, activity grids and logbooks. To facilitate the implementation of TCMs, decisions were made to clearly indicate their involvement in patients' files and concentrated their efforts on a restricted number of units. Barriers included confusion about target clientele, inequitable information exchange between partners, limited powers regarding coordination of care, and organizational constraints limiting additional measures to improve transitional care. Evaluating implementation processes is crucial to efficiently identify obstacles and apply additional implementation strategies to promote the integration of new practices within the health care system.