The network and care coordination of ambulatory healthcare providers for people with mobility impairments: a cross-sectional network study involving stroke survivors and people with spinal cord injury in Germany

BACKGROUND: People with mobility impairments such as stroke survivors or people with spinal cord injury (SCI) receive ambulatory healthcare from several healthcare providers. The coordination of these providers is challenging because there are usually no team meetings or shared treatment protocols. To gain insights into the coordinative processes of ambulatory care, the information transfer between providers was explored. METHODS: A cross-sectional network study was conducted in an urban community in the south-west of Germany. First, an exploratory internet search for local providers was conducted. Then, providers were asked to distribute a survey to their patients (stroke, SCI) to identify the provider network. This was followed by a survey of the providers named by the surveyed patients. Network analysis was applied to explore connections and network characteristics (density, centrality). RESULTS: Based on the patient survey (n = 22), a total of 58 healthcare providers in the community were identified, 20 of whom took part in the provider survey. In the network identified, physiotherapists, general practitioners, occupational therapists, orthopaedic technicians, neurologists, speech therapists and neuropsychologists were connected by 251 ties. The network had a density of 0.152 and a centrality of 0.442. Inter-organizational information sharing was only mentioned for 12 connections between healthcare providers. Care coordination in the community was rated as medium. CONCLUSION: Network analysis provided insight into a local network of healthcare providers. The network is dominated by a few providers and all providers have a low degree of connectivity. This study found that sharing of patient's information between providers is rarely implemented.