title: Understanding cross-boundary information flow for care coordination
title: The case of an alcohol care pathway
titleType: Subtitle
Creators: name: Platt, Nicola
Publisher: name: Lancaster University
Year: 2023

description: This thesis outlines a study into cross-boundary information exchange for coordination in an integrated alcohol care pathway. Effective information exchange between multidisciplinary teams is crucial for coordinated patient care. Alcohol use disorder (AUD) is both a social and a medical issue and a key public health priority. Patients with AUD pose particular care challenges due to a high probability of comorbidities, recurrent hospital admissions, poor patient outcomes and high costs to the health service. Care pathways act as a map of a patient’s expected care journey and highlight a multidisciplinary approach to patient care. For AUD patients, the multidisciplinary approach typically comprises care delivery across various clinical specialisms in the hospital, progressing to social care and ongoing support in the community following hospital discharge. Care pathways enable integrated care, requiring coordination across organisational and professional boundaries. Consequently, effective information exchange is essential. The use of Health Information Systems (HIS) can facilitate the exchange of structured clinical information. However, HIS use alone is not sufficient for effective information exchange for care coordination purposes and needs to be complemented with structural coordination mechanisms. Boundary spanning is a key coordination mechanism that acts as a bridge between domains, establishing links and facilitating information transfer. Yet, information exchange is only one part of a complex multi-step coordination process, comprising a range of boundary activities that take place at and across boundaries as part of the process. However, to date, there is little empirical evidence to explain how the complex coordination process takes place across boundaries in integrated care pathways, particularly in the novel setting of alcohol patient care. Therefore, the overarching objective of this research is to understand how care coordination is achieved through examining the cross-boundary interactions that facilitate data flow and information exchange across multiple health and social care boundaries in an alcohol care pathway. Adopting a qualitative single case study strategy, this research identified an exemplar case setting – a coastal town in North West England that at the time of this study had the highest number of alcoholrelated hospital admissions in England. Data was collected through semi-structured interviews with 41 participants from across the care pathway, including doctors, nurses, nformaticians, community support workers and patients. Interviews were complemented with direct observations and documentation and data was analysed thematically. Findings of this research highlight the complexity and the situated nature of care coordination. They highlight the emergent and proactive actions taken to initiate coordination and the need for continual preparation for future coordination requirements, in addition to present coordination needs, when treating this patient group. This thesis contributes to the literature on care coordination in two ways; firstly, by revealing the reactive and proactive nature of coordination in alcohol patient care; secondly, by revealing the differing temporal orientations adopted to achieve coordination. Additionally, this thesis contributes to the literature on boundary activities by highlighting the interplay between boundary spanning and boundary work to achieve coordination. Finally, this thesis contributes to the HIS literature through revealing how HIS and boundary activities jointly support care coordination in an alcohol care pathway. It is hoped that the findings of this study may help both academics and practitioners understand how the nuances of AUD contribute to the complexity of coordination across health and social care boundaries in alcohol care pathways.