Nguyen Oanh Kieu, Kruger Jenna, Greysen S Ryan, Lyndon Audrey, Goldman L Elizabeth
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
J Hosp Med. 2014 Nov;9(11):700-6. doi: 10.1002/jhm.2257. Epub 2014 Sep 11.
There is limited collaboration between hospitals and primary care despite parallel efforts to improve postdischarge care transitions.
To understand what primary care leaders perceived as barriers and facilitators to collaboration with hospitals.
Qualitative study with in-depth, semistructured interviews of 22 primary care leaders in 2012 from California safety-net clinics.
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.
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.
尽管为改善出院后护理过渡做出了并行努力，但医院与初级保健之间的合作仍然有限。
了解初级保健领导者认为与医院合作的障碍和促进因素是什么。
2012年对加利福尼亚安全网诊所的22名初级保健领导者进行了深入的半结构化访谈的定性研究。
合作的主要障碍包括缺乏合作的机构财务激励措施、相互竞争的优先事项（如监管要求、诊所能力紧张、财务压力）以及对初级保健在改善护理过渡方面的作用和能力的期望不匹配。促进因素包括通过人际网络建立关系，以及通过实施电子健康记录（EHR）改善沟通和信息传递。
改善护理过渡的努力应集中在调整财务激励措施、规范围绕电子健康记录互操作性和数据共享的法规，以及增加人际网络的机会上。
