Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report

Abstract

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.

Effects of a single-entry intake system on access to outpatient visits to specialist physicians and allied health professionals: a systematic review

“…12 The studies were published between 2004 and 2017, with most published after 2010. 6,11,[16][17][18][19] Overall, 9 articles used a simple comparative study design (pre-implementation v. post-implementation), 6,[10][11][12]14,15,[17][18][19] and 1 was cross-sectional. 16 The setting for evaluation of a single-entry model was surgery (orthopedics and general surgery) in 3 studies, 10,12,16 internal medicine (gastroenterology, rheumatology, cardiology, general internal medicine and nephrology) in 5 studies, 6,14,15,17,19 chronic pain in 1 study 11 and physiotherapy in 1 study.…”

“…16 The setting for evaluation of a single-entry model was surgery (orthopedics and general surgery) in 3 studies, 10,12,16 internal medicine (gastroenterology, rheumatology, cardiology, general internal medicine and nephrology) in 5 studies, 6,14,15,17,19 chronic pain in 1 study 11 and physiotherapy in 1 study. 18 All but one of the studies were conducted in a single-payer health care system, 6,[10][11][12][14][15][16][17][18] the exception involving a 2-tier system. 19 Three studies required mandatory implementation of a single-entry model, 14,18,19 whereas 7 reported on optional implementation.…”

“…18 All but one of the studies were conducted in a single-payer health care system, 6,[10][11][12][14][15][16][17][18] the exception involving a 2-tier system. 19 Three studies required mandatory implementation of a single-entry model, 14,18,19 whereas 7 reported on optional implementation. 6,[10][11][12][15][16][17] The implementation process for the single-entry model was described in all studies; however, implementation fidelity was described in only 3 articles.…”

Analysis of Clinical Value of Weight-Bearing Magnetic Resonance Diagnosis of Ankle Ligament Sports Injury

“…However, 20% to 30% of patients with ankle sprains will develop chronic ankle instability, which will cause repeated ankle sprains, joint relaxation or stiffness, traumatic arthritis, and cause joint dysfunction, which will seriously affect patients' daily lives. Surgical treatment should be given high attention [12]- [14].…”

Intelligent Medical Rehabilitation Training Instrument Based on Movement Coordination

“…Biofeedback technology has been used as an adjuvant treatment method for the treatment of post-stroke hemiplegia and the rehabilitation of neuromuscular function for more than 40 years. With the advancement of science and technology, biofeedback technology treatment measures have been greatly improved and gradually become stroke rehabilitation [10]- [14]. One of the comprehensive measures is for effective treatment [15]- [18].…”