title: Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination.
abstract: BACKGROUND
  Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary-hospital care continuum.
  
  
  METHODS
  This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results.
  
  
  RESULTS
  The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other's roles, expectations and competences and building qualitative relationships.
  
  
  CONCLUSIONS
  Care pathways across the primary-hospital care continuum enhance the components of care coordination.
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, box 7001, 3000 Leuven, Belgium. sabine.vanhoudt@med.kuleuven.be
authors.forename: Sabine
authors.initials: S
authors.lastname: Van Houdt
authors.forename: Jan
authors.initials: J
authors.lastname: Heyrman
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.forename: Jan
authors.initials: J
authors.lastname: De Lepeleire
mesh_terms: D001530:Belgium; D019058:Community Networks; D003266:Continuity of Patient Care; D019091:Critical Pathways; D017144:Focus Groups; D006760:Hospitalization; D006801:Humans; D011320:Primary Health Care; D036301:Qualitative Research; D011787:Quality of Health Care
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