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The Challenge of Improving Breast Cancer Care Coordination in Safety-net Hospitals: Barriers, Facilitators, and Opportunities

McAlearney, Ann Scheck ScD, MS*,†; Murray, Kelsey BS*; Sieck, Cynthia PhD, MPH*; Lin, Jenny J. MD; Bellacera, Bonnie MPH; Bickell, Nina A. MD, MPH

doi: 10.1097/MLR.0000000000000458
Original Articles

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.

Research Design: 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.

Subjects: 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.

*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

Supported by the National Cancer Institute Grant R01-CA 149025.

The authors declare no conflict of interest.

Reprints: Ann S. McAlearney, ScD, MS, Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, 273 Northwood and High Building, Columbus, OH 43201. E-mail:

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