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Management of Test Results in Family Medicine Offices

¹ Department of Family Medicine, University of Cincinnati, Cincinnati, Ohio
² Department of Psychology, Wright State University, Dayton, Ohio
³ Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, Ohio

CORRESPONDING AUTHOR: Nancy C. Elder, MD, MSPH Department of Family Medicine University of Cincinnati PO Box 670582 Cincinnati, OH 45267-0582 eldernc{at}fammed.uc.edu

PURPOSE We wanted to explore test results management systems in family medicine offices and to delineate the components of quality in results management.

METHODS Using a multimethod protocol, we intensively studied 4 purposefully chosen family medicine offices using observations, interviews, and surveys. Data analysis consisted of iterative qualitative analysis, descriptive frequencies, and individual case studies, followed by a comparative case analysis. We assessed the quality of results management at each practice by both the presence of and adherence to systemwide practices for each results management step, as well as outcomes from chart reviews, patient surveys, and interview and observation notes.

RESULTS We found variability between offices in how they performed the tasks for each of the specific steps of results management. No office consistently had or adhered to office-wide results management practices, and only 2 offices had written protocols or procedures for any results management steps. Whereas most patients surveyed acknowledged receiving their test results (87% to 100%), a far smaller proportion of patient charts documented patient notification (58% to 85%), clinician response to the result (47% to 84%), and follow-up for abnormal results (28% to 55%). We found 2 themes that emerged as factors of importance in assessing test results management quality: safety awareness—a leadership focus and communication that occurs around quality and safety, teamwork in the office, and the presence of appropriate policies and procedures; and technological adoption—the presence of an electronic health record, digital connections between the office and testing facilities, use of technology to facilitate patient communication, and the presence of forcing functions (built-in safeguards and requirements).

CONCLUSION Understanding the components of safety awareness and technological adoption can assist family medicine offices in evaluating their own results management processes and help them design systems that can lead to higher quality care.

Key Words: Delivery of health care • quality of care • patient safety • medical errors, office management, qualitative research

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