A web-based communication system for integrated care in cerebral palsy: experienced contribution to parent-professional communication.

INTRODUCTION: To improve communication in the integrated care setting of children with cerebral palsy, we developed a web-based system for parent-professional and inter-professional communication. The present study aimed to evaluate parents' experiences regarding the system's contribution to their communication with professionals during a six-months pilot in three Dutch care regions. In addition, factors associated with parents' system use and non-use were analyzed. THEORY AND METHODS: The system's functional specifications were based on key elements of the Chronic Care Model and quality dimensions formulated by the Institute of Medicine. At baseline, parents completed a T0-questionnaire on their experiences regarding sufficiency of contact, accessibility of professionals, timeliness of information exchange, consistency of information and parents' role as messenger of information and/or care coordinator. After the pilot, parents completed a T1-questionnaire on their experiences regarding the system's contribution to each of these aspects. RESULTS: Of the 30 participating parents 21 had used the system, of which 20 completed the T1-questionnaire. All these parents indicated that they had experienced a contribution of the system to parent-professional communication, especially with respect to accessibility of professionals, sufficiency of contact and timeliness of information exchange, and to a lesser extent consistency of information and parents' messenger/coordinator role. In comparison with non-users, users had less positive baseline experiences with accessibility and a higher number of professionals in the child's care network. CONCLUSIONS: All users indicated a contribution of the system to parent-professional communication, although the extent of the experienced contribution varied considerably. Based on the differences found between users and non-users, further research might focus on the system's value for complex care networks and problematic access to professionals.

Determinants of use and non-use of a web-based communication system in cerebral palsy care: evaluating the association between professionals' system use and their a priori expectancies and background.

BACKGROUND: Previously we described parents' and professionals' experiences with a web-based communication system in a 6-month pilot in three Dutch cerebral palsy care settings. We found that half of the participating professionals had not used the system, and of those who had used the system one third had used it only once. The present study aimed to evaluate whether professionals' system use was associated with their a priori expectancies and background. METHODS: Professionals who had not used the system (n = 54) were compared with professionals who had used the system more than once (n = 46) on the basis of their questionnaire responses before the pilot, their affiliation and the number of patients which they represented in the study. The questionnaire items comprised professionals' expectancies regarding the system's performance and ease of use, as well as the expected time availability and integration into daily care practice. RESULTS: Overall, users had higher a priori expectancies than non-users. System use was associated with expected ease of use (p = .046) and time availability (p = .005): 50% of the users (vs. 31% of the non-users) expected that the system would be easy to use and 93% of the users (vs. 72% of the non-users) expected that they would be able to reserve a time slot each week for responding to submitted questions. With respect to professionals' affiliation, system use was associated with professionals' institution (p = .003) and discipline (p = .001), with more (para-) medical professionals among users (93% vs. 63% among non-users), and more education professionals among non-users (37% vs. 7% among users). In addition, users represented more patients (mean 2, range 1-8) than non-users (mean 1.1, range 1-2) (p = .000). CONCLUSIONS: Professionals' system use was associated with expected ease of use and time availability, professionals' affiliation and the number of represented patients, while no association was found with expected performance of the system. To achieve higher adoption rates in the future, it is important to further develop the technology by optimizing the system's ease of use and interoperability and including advanced consultation options. In addition, better identified end users should be more extensively informed about the system's possibilities through tailored education.

A web-based communication system for integrated care in cerebral palsy: design features, technical feasibility and usability.

We developed a secure, web-based system for parent-professional and inter-professional communication. The aim was to improve communication in the care of children with cerebral palsy. We conducted a six-month trial of the system in three Dutch health-care regions. The participants were the parents of 30 cerebral palsy patients and 120 professional staff involved in their care. Information about system usage was extracted from the system's database. The experience of the parents and professionals was evaluated by a questionnaire after six months. The system proved to be technically robust and reliable. A total of 21 parents (70%) and 66 professionals (55%) used the system. The parents submitted 111 questions and 59 responses, with a mean of 5 questions (range 1-17) and 3 responses (range 1-9) per parent. The professionals submitted 79 questions and 237 responses, with a mean of 2 questions (range 1-8) and 4 responses (range 1-23) per professional. Most parents (95%) and some professionals (30%) reported value in using the system, which ranged from efficiency and accessibility to flexibility and transparency. The web-based communication system was technically feasible and produced improved parent-professional and inter-professional communication. It may be especially valuable if frequent interventions or consultations about a child's care are required, involving complex care networks of different professionals and organisations.