Care Coordination in Pediatric Physical Therapy: barriers and Facilitators

Purpose/Hypothesis: Pediatric physical therapists play an integral role in care coordination for children with complex health needs. The purpose of this study is to conduct an in-depth exploration of the experiences and perceptions by expert pediatric physical therapists in performing care coordination activities.

Number of Subjects: Ten pediatric physical therapists participated and primarily practice in Wisconsin and Illinois. They have between two and twenty-seven years of clinical experience. They represent a variety of settings including school-based, outpatient, acute care, and home therapy.

Materials/Methods: Individualized semi-structured interviews were conducted via Zoom. Methods of recruitment included electronic postings in the Academy of Pediatric Physical Therapy newsletter and snowball sampling. Interview questions were developed based on the integrative care model. Interviews were recorded, transcribed, and checked for accuracy. Deductive content analysis methods were employed in the data analysis.

Results: Four groups emerged from the data: (1) patient/family, (2) individual therapist, (3) care team, and (4) health/education system. Themes of barriers and facilitators emerged for each group. Barriers identified for the patient/family group included negative social and behavioral factors, insufficient knowledge and resources, and high unmet needs. Individual therapist factors included insufficient information, lack of time, and difficulty in communicating with stakeholders. Care team factors included challenging interpersonal dynamics, inefficient documentation, and resistance to change in practice. Health and school systems factors included privacy concerns, restrictions for in person contact, productivity expectations, inaccuracies in the health/school record, poor adoption of technology, waitlist for therapy and lack of support in documentation and trainings. Facilitators identified for the patient/family group include developed self-efficacy skills, knowledge and access to resources, consistency of providers, and family involvement. Individual therapist factors included developed professionalism, effective communication skills, consistency of caseload, access to and adoption of technology. Care teams included positive personal relationships, established triage system for workflow, and professionalism. Health and education system factors included access and use of technology, work policies to allow for non-patient care time and documentation support.

Conclusions: This research illustrates the complexity of care coordination and identifies common themes for barriers and facilitators that apply across care settings. This understanding is necessary for successful adoption of strategies to improve patient care and outcomes.

Clinical Relevance: Identification of barriers and facilitators for care coordination using a systems approach can be useful for clinicians to target interventions to improve quality of care.