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Methods
Our qualitative study consisted of three focus groups followed by nine semi-structured interviews. These were conducted at the Jen Center for Primary Care, an academic internal medicine practice at Brigham and Women’s Hospital that provides care to 19,000 patients. One-third of its diverse population derives from the hospital’s underserved urban surroundings, a similar fraction receives public insurance and 13% is non-English speaking. Six thousand of the practice’s patients have diabetes and many suffer from multiple chronic diseases. 20% of the Jen Center’s patients are over the age of 65.
The Jen Center, which recently transitioned to team-based care, employs 42 faculty physicians and 64 residents. Its 57 other staff members consist of nurse practitioners (NPs), physician assistants, registered nurses, pharmacist technicians, licensed practical nurses (LPNs), medical assistants (MAs), secretaries, social workers (SWs), pharmacists and care coordination nurses. Our study was exempt from Institutional Review Board approval due to its quality improvement focus.
Focus groups consisted of 17 self-selected staff members (two SWs, two primary care physicians (PCPs), two secretaries, five nurses, a pharmacist technician, an NP, a practice manager, a resident, an LPN and an MA) who met three times for one hour over the course of six months. Focus groups garnered staff opinions about the general scope and appearance of an ECP, key team-based care components of an ECP, and potential ECP features of interest. They were led by author CW. A preliminary ECP mock-up was designed based on themes derived from focus groups.
Individual, semi-structured, 18-question interviews were subsequently conducted with nine TMs (three nurses, a resident, two SWs, a PCP, a pharmacist, and a secretary). All interviewees were uncompensated volunteers who were ensured of confidentiality and given an opportunity to decline participation without repercussion. Six had participated in focus groups. In addition to being asked to describe potential benefits and drawbacks of an ECP, participants were asked to prioritize several specific ECP features on a 1–5 scale, detail additional useful ECP components, and to provide feedback on the ECP mock-up.
Deidentified data from focus groups and interviews were electronically transcribed by authors ST and LR. Data were explored via content analysis. ST reviewed interview transcripts to code commonly mentioned phrases and preference patterns. Codes were transformed into themes that identified key components of an ECP; themes were revised as additional data became available. LR independently reviewed the coding process and analyses were compared for discrepancies.
We subsequently iterated and finalized the ECP mockup based on interview findings.
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