title: Focus groups to explore healthcare professionals' experiences of care coordination: towards a theoretical framework for the study of care coordination.
abstract: BACKGROUND
  Strategies to improve care coordination between primary and hospital care do not always have the desired results. This is partly due to incomplete understanding of the key concepts of care coordination. An in-depth analysis of existing theoretical frameworks for the study of care coordination identified 14 interrelated key concepts. In another study, these 14 key concepts were further explored in patients' experiences. Additionally, "patient characteristics" was identified as a new key concept in patients' experiences and the previously identified key concept "quality of relationship" between healthcare professionals was extended to "quality of relationship" with the patient. Together, these 15 interrelated key concepts resulted in a new theoretical framework. The present study aimed at improving our understanding of the 15 previously identified key concepts and to explore potentially previous unidentified key concepts and the links between these by exploring how healthcare professionals experience care coordination.
  
  
  METHODS
  A qualitative design was used. Six focus groups were conducted including primary healthcare professionals involved in the care of patients who had breast cancer surgery at three hospitals in Belgium. Data were analyzed using constant comparative analysis.
  
  
  RESULTS
  All 15 previously identified key concepts of care coordination were further explored in healthcare professionals' experiences. Links between these 15 concepts were identified, including 9 newly identified links. The concept "external factors" was linked with all 6 concepts relating to (inter)organizational mechanisms; "task characteristics", "structure", "knowledge and information technology", "administrative operational processes", "cultural factors" and "need for coordination". Five of these concepts related to 3 concepts of relational coordination; "roles", "quality of relationship" and "exchange of information". The concept of "task characteristics" was only linked with "roles" and "exchange of information". The concept "patient characteristics" related with the concepts "need for coordination" and "patient outcome". Outcome was influenced by "roles", "quality of relationship" and "exchange of information".
  
  
  CONCLUSIONS
  External factors and the (inter)organizational mechanism should enhance "roles" and "quality of relationship" between healthcare professionals and with the patient as well as "exchange of information", and setting and sharing of common "goals" to improve care coordination and quality of care.
authors.affiliation: Department of Public Health & Primary Care, Academic Center for General Practice, KULeuven - University of 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.affiliation: Department of Public Health & Primary Care, Center for Health Services & Nursing Research, KULeuven - University of Leuven, Kapucijnenvoer 35 blok D box 7001, 3000, Leuven, Belgium. walter.sermeus@med.kuleuven.be.
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.affiliation: Department of Public Health & Primary Care, Center for Health Services & Nursing Research, KULeuven - University of Leuven, Kapucijnenvoer 35 blok D box 7001, 3000, Leuven, Belgium. kris.vanhaecht@med.kuleuven.be.|Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. kris.vanhaecht@med.kuleuven.be.
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.affiliation: Department of Public Health & Primary Care, Academic Center for General Practice, KULeuven - University of Leuven, Kapucijnenvoer 33 blok J box 7001, 3000, Leuven, Belgium. jan.delepeleire@med.kuleuven.be.
authors.forename: Jan
authors.initials: J
authors.lastname: De Lepeleire
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D066275:Health Information Exchange; D006760:Hospitalization; D006801:Humans; D064691:Nurses, Community Health; D010346:Patient Care Management; D018802:Patient-Centered Care; D059825:Physical Therapists; D010821:Physicians, Family; D011320:Primary Health Care; D024382:Professional Role; D036301:Qualitative Research