title: Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators' Perspectives.
abstract: BACKGROUND
  Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. This is the first study describing experiences of care coordinators across the US from their own perspectives.
  
  
  METHODS
  This qualitative study used a 5-month private, online discussion forum to gather data from 25 care coordinators from PCMH practices representing diversity in practice size, setting, and type. Participants answered questions and interacted with one another, creating an online social learning collaborative while allowing for data collection for research.
  
  
  RESULTS
  Coordinators identified barriers and facilitators in their work at the organization/system level, the interpersonal level, and the individual level. Some factors emerged as both barriers and facilitators, including the functionality of clinical information technology; the availability of community resources; interactions with clinicians and other health care facilities; interactions with patients; and self-care practices for mental health and wellness. Colocation and full integration into practices were other key facilitators, whereas excessive case loads and data management responsibilities were felt to be important barriers.
  
  
  CONCLUSIONS
  While all the barriers and facilitators were important to performing coordinators' roles, relationship building materialized as key to effective care coordination, whether with clinicians, patients, or outside organizations. We discuss implications for practice and provide suggestions for further research.
authors.affiliation: From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS). asiaf@udel.edu.
authors.forename: Asia
authors.initials: A
authors.lastname: Friedman
authors.affiliation: From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS).
authors.forename: Jenna
authors.initials: J
authors.lastname: Howard
authors.affiliation: From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS).
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shaw
authors.affiliation: From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS).
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS).
authors.forename: Laleh
authors.initials: L
authors.lastname: Shahidi
authors.affiliation: From the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE (AF); the Department of Family Medicine and Community Health, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ (JH, JMF); the Department of Community Medicine, Mercer University School of Medicine, Savannah, GA (EKS); the Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC); and APS Consulting, San Ramon, CA (LS).
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Ferrante
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D020407:Internet; D007400:Interprofessional Relations; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration* / Q000592:standards; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D014481:United States
keywords: Delivery of Health Care; Internet; Patient-centered Care; Primary Health Care; Qualitative Research