Inter-agency collaboration in the care of children with complex chronic conditions

The purpose of this article was to describe the network of collaboration among agencies that serve children with complex chronic conditions (CCCs) and identify gaps in the network.

We surveyed representatives from agencies that serve children with CCCs in Forsyth County, North Carolina, about their agencies' existing and desired collaborations with other agencies in the network. We used Social Network Analytical (SNA) methods to describe gaps in the network. Mean out-degree and in-degree centrality (number of collaborative ties extending from or directed toward an agency) and density (ratio of extant ties to all possible ties) were measured.

In this network with 3658 possible collaborative ties, care-coordination agencies and pediatric practices reported the highest existing collaborations with other agencies (out-degree centrality: 32 and 30, respectively). Pediatric practices reported strong ties with subspecialty clinics (density: 73%), but weak ties with family support services (density: 3%). Pediatric practices and subspecialty clinics (in-degree: 26) received the highest collaborative ties from other agencies. Support services and durable medical equipment (DME) companies reported low ties with other agencies (out-degree: 7 and 10, respectively). Nursing agencies reported the highest desired collaborations (out-degree: 18). Support services, pediatric practices, and care-coordination programs had the highest in-degree centrality (7, 6, and 6, respectively) for desired collaborations. Nursing agencies and support services had the greatest gaps in collaboration.

Although collaboration exists among agencies serving children with CCCs, there are many gaps in the network. Future studies should explore barriers and facilitators to inter-agency collaborations and whether increased collaboration in the network improves patient-level outcomes.