From fragmentation to coordination: sustainable service pathways for persons with brain injury

Abstract Background Rising healthcare costs, limited resources, and fragmented systems challenge the sustainability of public health and social security. Persons with disabilities, especially those with acquired brain injury (ABI), face compounded risks due to service disconnection. In Switzerland, despite comprehensive social security schemes, fragmented service delivery, regional disparities, and rigid deadlines hamper effective coordination-especially within disability insurance, which seeks to support work capacity and prevent long-term disability. Objectives This study aimed to (1) examine current service provision dynamics and interactions across sectors for persons with ABI, and (2) define key components of an optimal, lifelong service pathway supporting sustainable employment. Methods Using an Integrated Knowledge Translation approach, we partnered with knowledge users across healthcare, insurance, and policy to identify barriers and co-create solutions. We conducted a three-phase process-reviewing existing data, mapping the current ("As-Is") system, and envisioning an ideal pathway-drawing from prior research and new surveys with neurorehabilitation centers and disability insurance offices. Results The current service landscape for ABI reveals critical gaps grouped into four domains: information, communication, coordination, and financing. Individuals and families often lack clarity about care steps and entitlements. Fragmented systems and minimal case management obstruct vocational reintegration. Financial insecurity, delayed support, and brief rehabilitation further undermine outcomes. Stakeholders underscored the need for lifelong case management and ABI-specific care guidelines. Conclusions Coordinated service pathways enhance care by revealing structural barriers and guiding targeted action. Engaging diverse stakeholders in co-design strengthens policy relevance and implementation, helping bridge critical gaps in lifelong support for people with ABI. Key messages • Identifying key service gaps helps improve lifelong support for people with ABI and strengthens their chances of sustainable employment. • Co-designed pathways with stakeholders enhance coordination and drive practical policy change for ABI care in Switzerland.