Factors Associated with Collaboration Among Agencies Serving Children with Complex Chronic Conditions

Our objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children
with complex chronic conditions (CCC). We hypothesized that an agency will collaborate with more partners in the network if
the agency had a coordinator and participated in a community coalition. We surveyed representatives of 63 agencies that serve
children with CCC in Forsyth County, North Carolina about their agencies’ collaborations with other agencies. We used social
network analytical methods and exponential random graph analysis to identify factors associated with collaboration among agencies.
The unit of analysis was the collaborative tie (n = 3,658) between agencies in the network. Agencies participating in a community
coalition were 1.5 times more likely to report collaboration than agencies that did not participate in a coalition. Presence
of a coordinator in an agency was not associated with the number of collaborative relationships. Agencies in existence for
a longer duration (≥11 vs. ≤10 years; adjusted odds ratio (aOR): 2.1) and those with a higher proportion of CCC clientele
(aOR: 2.1 and 1.6 for 11–30 % and ≥31 % compared to ≤10 %) had greater collaboration. Care coordination agencies and pediatric
practices reported more collaborative relationships than subspecialty clinics, home-health agencies, durable medical equipment
companies, educational programs and family-support services. Collaborative relationships between agencies that serve children
with CCC are increased by coalition participation, longer existence and higher CCC clientele. Future studies should evaluate
whether interventions to improve collaborations among agencies will improve clinical outcomes of children with CCC.