title: Understanding how to improve collaboration between hospitals and primary care in postdischarge care transitions: a qualitative study of primary care leaders' perspectives.
abstract: BACKGROUND
  There is limited collaboration between hospitals and primary care despite parallel efforts to improve postdischarge care transitions.
  
  
  OBJECTIVE
  To understand what primary care leaders perceived as barriers and facilitators to collaboration with hospitals.
  
  
  METHODS
  Qualitative study with in-depth, semistructured interviews of 22 primary care leaders in 2012 from California safety-net clinics.
  
  
  RESULTS
  Major barriers to collaboration included lack of institutional financial incentives for collaboration, competing priorities (e.g., regulatory requirements, strained clinic capacity, financial strain) and mismatched expectations about role and capacity of primary care to improve care transitions. Facilitators included relationship building through interpersonal networking and improving communication and information transfer via electronic health record (EHR) implementation.
  
  
  CONCLUSIONS
  Efforts to improve care transitions should focus on aligning financial incentives, standardizing regulations around EHR interoperability and data sharing, and enhancing opportunities for interpersonal networking.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Oanh Kieu
authors.initials: OK
authors.lastname: Nguyen
authors.forename: Jenna
authors.initials: J
authors.lastname: Kruger
authors.forename: S Ryan
authors.initials: SR
authors.lastname: Greysen
authors.forename: Audrey
authors.initials: A
authors.lastname: Lyndon
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
mesh_terms: D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D002140:California; D003266:Continuity of Patient Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003299:Cooperative Behavior; D057286:Electronic Health Records; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010351:Patient Discharge / Q000191:economics / Q000592:standards*; D010359:Patient Readmission / Q000191:economics / Q000331:legislation & jurisprudence*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D012052:Reimbursement, Incentive; D064876:Safety-net Providers / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*