title: Information exchange networks for chronic illness care in primary care practices: an observational study.
abstract: BACKGROUND
  Information exchange networks for chronic illness care may influence the uptake of innovations in patient care. Valid and feasible methods are needed to document and analyse information exchange networks in healthcare settings. This observational study aimed to examine the usefulness of methods to study information exchange networks in primary care practices, related to chronic heart failure, diabetes and chronic obstructive pulmonary disease.
  
  
  METHODS
  The study was linked to a quality improvement project in the Netherlands. All health professionals in the practices were asked to complete a short questionnaire that documented their information exchange relations. Feasibility was determined in terms of response rates and reliability in terms of reciprocity of reports of receiving and providing information. For each practice, a number of network characteristics were derived for each of the chronic conditions.
  
  
  RESULTS
  Ten of the 21 practices in the quality improvement project agreed to participate in this network study. The response rates were high in all but one of the participating practices. For the analysis, we used data from 67 health professionals from eight practices. The agreement between receiving and providing information was, on average, 65.6%. The values for density, centralization, hierarchy, and overlap of the information exchange networks showed substantial variation between the practices as well as between the chronic conditions. The most central individual in the information exchange network could be a nurse or a physician.
  
  
  CONCLUSIONS
  Further research is needed to refine the measure of information networks and to test the impact of network characteristics on the uptake of innovations.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P,O, Box 9101, 6500 HB, Nijmegen, the Netherlands. M.Wensing@iq.umcn.nl
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Jan
authors.initials: J
authors.lastname: Koetsenruiter
authors.forename: David
authors.initials: D
authors.lastname: Reeves