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The Testing Process in Family Medicine: Problems, Solutions and Barriers as Seen by Physicians and Their Staff: A study of the American Academy of Family Physicians' National Research Network

Elder, Nancy C. MD, MSPH*; Graham, Deborah MSPH; Brandt, Elias; Dovey, Susan PhD, MPH; Phillips, Robert MD, MSPH†§; Ledwith, James MD; Hickner, John MD, MSc

Original Articles

Objective: Family physicians order laboratory, imaging, and diagnostic tests on a significant portion of their patients. Problems with the testing process, including the steps of ordering tests, tracking and responding to results, notifying patients, and following up with patients, and potential improvement strategies have not been well described. Our objective is to assess problems with the testing process, potential solutions, and barriers to implementation of solutions, as perceived by family physicians and their office staff.

Methods: Focus groups were held with physicians and staff at 8 geographically diverse practices of the American Academy of Family Physicians' National Research Network who were participating in an errors-reporting study. Participants were asked about testing process errors, problems, and potential improvements. Analysis was by the editing method.

Results: A total of 139 people participated in 18 focus groups. Participants identified problems with all steps in the testing process, and also noted that filing and charting problems existed in most steps in the testing process. Underlying contributing factors included not following procedures, inadequate systems, lack of standardization, and communication problems. Perceived barriers to improvements were both cultural (leadership and staff support, tension for change) and process-related (costs, staff and work environment, external support). Desired improvements included technology, more staffing, and improved systems.

Conclusions: Family physicians and their staff easily identified errors and their contributing factors in their testing processes. Desired improvements tended to be quick fixes that may not adequately address the identified errors and barriers to improved safety in the testing process.

From the *Department of Family Medicine, University of Cincinnati, Cincinnati, Ohio; †American Academy of Family Physicians, Leawood, KS; ‡University of Otago, Dunedin, New Zealand; §Robert Graham Center for Health Care Policy, Washington DC; ∥CHC Family Medicine, Fitchburg, Massachusetts; and ¶Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.

Funded through the Agency for Healthcare Research and Quality, grant 5 R21 HS013554-02.

Correspondence: Nancy C. Elder, MD, MSPH, Department of Family Medicine, University of Cincinnati, PO Box 670582, Cincinnati, OH 45267-0582 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.