title: The Challenge of Improving Breast Cancer Care Coordination in Safety-net Hospitals: Barriers, Facilitators, and Opportunities.
abstract: BACKGROUND
  Minority breast cancer patients tend to have higher rates of adjuvant treatment underuse. We implemented a web-based intervention that closes referral loops between surgeons and oncologists at inner-city safety-net hospitals serving high volumes of minority breast cancer patients to assist these hospitals and improve care coordination.
  
  
  METHODS
  Following intervention implementation, we conducted interviews with key personnel to improve our understanding of the implementation process and to identify barriers, facilitators, and opportunities for improvement. We used the constant comparative method of analysis to code interview transcripts and identify common themes regarding intervention implementation.
  
  
  METHODS
  We interviewed 64 administrative and clinical key informants from 10 inner-city safety-net hospitals with high volumes of minority breast cancer patients.
  
  
  RESULTS
  We found substantial barriers to implementing an intervention designed to support care coordination efforts, despite initial feedback that the intervention itself was both easy to use and in line with organizational goals. We also characterized facilitators and challenges of breast cancer care coordination in the safety-net environment, as well as opportunities to improve intervention design to support increased quality of breast cancer care.
  
  
  CONCLUSIONS
  Coordination of care for women with breast cancer is extremely important, but safety-net hospitals face considerable resource constraints from lack of time, support, and information systems. As safety-net hospital networks grow across numerous care sites, the challenge of care coordination will likely increase, highlighting the importance of interventions that can be successfully implemented and used to promote better care.
authors.affiliation: *Department of Family Medicine, College of Medicine †Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH ‡Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY.
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
authors.forename: Kelsey
authors.initials: K
authors.lastname: Murray
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sieck
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Lin
authors.forename: Bonnie
authors.initials: B
authors.lastname: Bellacera
authors.forename: Nina A
authors.initials: NA
authors.lastname: Bickell
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D054625:Healthcare Disparities; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D064876:Safety-net Providers / Q000458:organization & administration*