Assignment #1: Abstract for Proposed Qualitative Research Project

Jonathan Lee Qualitative Research Methods Research question What are the individual- and system-level barriers to communication and follow-up of subcritical radiology and laboratory test results? Significance and background Though prior studies have demonstrated poor rates of appropriate and timely follow-up of subcritical laboratory and radiology test results, further study is needed to identify specific barriers for intervention for this critical patient safety issue that can lead to delayed diagnoses, poor patient outcomes and closed malpractice claims. Proposed approach We will conduct a qualitative study using semi-structured focus groups (n=8) with healthcare providers from purposefully sampled primary and subspecialty care departments affiliated with San Francisco General Hospital (SFGH). Invitations to participate in focus groups will be sent by e-mail. An interview guide will be developed. Each focus group will last 30-60 minutes and food will be provided to incentivize participants. All focus groups will be recorded and transcribed. We will use an inductive framework to identify emergent themes from the focus group transcripts. Two researchers will independently code each transcript followed by comparisons to develop a consensus coding structure. Similar codes will be merged and duplicate codes eliminated through an iterative process to develop a codebook. Codes will be grouped into major themes and relationships among themes will be identified. Proposed subjects The study will be conducted at SFGH, an urban health system with a large public hospital, comprehensive ambulatory specialty care, and hospital- and community-based primary care clinics. SFGH also represents San Francisco’s largest safety net hospital. Focus groups will be conducted with SFGH healthcare providers (physicians, nurses and nurse practitioners) from purposefully sampled groups. Three separate focus groups will be conducted with physician leaders from radiology, hospital medicine, and the emergency department. Two focus groups will be conducted with multidisciplinary healthcare providers from the SFGH ambulatory care committee, a group focused on the communication and integration of outpatient services on and off the SFGH campus, and from risk management. Three additional focus groups will be conducted with frontline primary care, hospital medicine and emergency medicine providers to confirm our findings.   Anticipated or current challenges 1. Is this enough data for the job? Are the 8 planned focus groups sufficient to address our research question comprehensively with thematic saturation? 2. Generalizability of results to other hospital systems Some of the barriers identified may be specific to SFGH and less generalizable to other hospital systems.