title: Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models.
abstract: BACKGROUND
  Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient's experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity.
  
  
  METHODS
  Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8.
  
  
  RESULTS
  The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors.
  
  
  CONCLUSIONS
  The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader 'fit' with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved.
authors.affiliation: Australian Primary Health Care Research Institute, Level 1, Ian Potter House, Cnr Gordon & Marcus Clarke Sts, The Australian National University, Canberra, ACT 0200, Australia. Michelle.Banfield@anu.edu.au
authors.forename: Michelle
authors.initials: M
authors.lastname: Banfield
authors.forename: Karen
authors.initials: K
authors.lastname: Gardner
authors.forename: Ian
authors.initials: I
authors.lastname: McRae
authors.forename: James
authors.initials: J
authors.lastname: Gillespie
authors.forename: Robert
authors.initials: R
authors.lastname: Wells
authors.forename: Laurann
authors.initials: L
authors.lastname: Yen
mesh_terms: D001315:Australia; D019090:Case Management / Q000191:economics / Q000458:organization & administration*; D003219:Confidentiality / Q000331:legislation & jurisprudence; D003266:Continuity of Patient Care / Q000191:economics / Q000458:organization & administration*; D019091:Critical Pathways / Q000191:economics / Q000458:organization & administration; D057286:Electronic Health Records; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D017146:Models, Organizational; D009042:Motivation; D010067:Ownership / Q000331:legislation & jurisprudence; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D058996:Quality Improvement; D012017:Referral and Consultation