title: Key factors in patient-centered care coordination in ambulatory care: nurse care coordinators' perspectives.
abstract: BACKGROUND
  Care coordination within Health Care Homes (HCHs) is an evolving registered nurse role. The purpose of this study was to identify factors influencing nurse care coordination.
  
  
  OBJECTIVE
  The aims are to 1) describe the characteristics of patients perceived by nurse care coordinators (NCCs) to benefit from care coordination and to 2) describe interventions judged by NCCs to be most effective in caring for patients with complex chronic care needs.
  
  
  METHODS
  This study was an analysis of existing data using a qualitative descriptive design. Experienced NCCs from various practice settings participated in a focus group. Data were analyzed using content analysis.
  
  
  RESULTS
  Findings indicate the importance of the cumulative impact of complex health problems, limited social support, culture and language on patients needing care coordination. Effective interventions are focused on providing holistic, relationship-based care.
  
  
  CONCLUSIONS
  The identification of contextual factors juxtaposed to complex chronic health conditions holds promise as a powerful indicator of individuals needing targeted, individualized interventions.
authors.affiliation: Department of Nursing, Nursing Research Division, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA. Electronic address: vanderboom.catherine@mayo.edu.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Vanderboom
authors.affiliation: Department of Nursing, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA. Electronic address: nthackeray@mayo.edu.
authors.forename: Nona L
authors.initials: NL
authors.lastname: Thackeray
authors.affiliation: Department of Nursing, Nursing Research Division, Mayo Clinic, University of Minnesota, 200 First Street, Rochester, MN 55905, USA. Electronic address: rhudy.lori@mayo.edu.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Rhudy
mesh_terms: D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D006801:Humans; D009732:Nursing Care / Q000379:methods; D018802:Patient-Centered Care / Q000379:methods*
keywords: Chronic illness; Nurse care coordination; Nurse perspectives; Qualitative research