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Research ArticleOriginal Research

Patient Safety in Primary Care: Conceptual Meanings to the Health Care Team and Patients

Alden Yuanhong Lai, Christina T. Yuan, Jill A. Marsteller, Susan M. Hannum, Elyse C. Lasser, JaAlah-Ai Heughan, Tyler Oberlander, Zackary D. Berger, Ayse P. Gurses, Hadi Kharrazi, Samantha I. Pitts, Sarah H. Scholle and Sydney M. Dy
The Journal of the American Board of Family Medicine September 2020, 33 (5) 754-764; DOI: https://doi.org/10.3122/jabfm.2020.05.200042
Alden Yuanhong Lai
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
PhD
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Christina T. Yuan
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
PhD
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Jill A. Marsteller
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
PhD
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Susan M. Hannum
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
PhD
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Elyse C. Lasser
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
MS
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JaAlah-Ai Heughan
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
MS
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Tyler Oberlander
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
BA
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Zackary D. Berger
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
MD
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Ayse P. Gurses
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
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Hadi Kharrazi
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
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Samantha I. Pitts
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
MD
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Sarah H. Scholle
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
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Sydney M. Dy
From the Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (AYL); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (CTY, JAM, ECL, J-AH, APG, HK, SMD); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG, SIP, SMD); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (CTY, JAM, APG); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore (SMH, ZDB); National Committee for Quality Assurance, Washington DC (TO, SHS); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (ZDB, SIP, SMD); Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore (APG, HK).
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Abstract

Introduction: Patient safety in primary care is an emerging priority, and experts have highlighted medications, diagnoses, transitions, referrals, and testing as key safety domains. This study aimed to (1) describe how frontline clinicians, administrators, and staff conceptualize patient safety in primary care; and (2) compare and contrast these conceptual meanings from the patient's perspective.

Methods: We conducted interviews with 101 frontline clinicians, administrators and staff, and focus groups with 65 adult patients at 10 patient-centered medical homes. We used thematic analysis to approach coding.

Results: Findings indicate that frontline personnel conceptualized patient safety more in terms of work functions, which reflect the grouping of tasks or responsibilities to guide how care is being delivered. Frontline personnel and patients conceptualized patient safety in largely consistent ways.

Discussion: Function-based conceptualizations of patient safety in primary care may better reflect frontline personnel and patients' experiences than domain-based conceptualizations, which are favored by experts.

  • Administrative Personnel
  • Focus Groups
  • Patient Safety
  • Patient-Centered Care
  • Practice-Based Research
  • Primary Health Care
  • Qualitative Research
  • Referral and Consultation
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The Journal of the American Board of Family     Medicine: 33 (5)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 5
September/October 2020
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Patient Safety in Primary Care: Conceptual Meanings to the Health Care Team and Patients
Alden Yuanhong Lai, Christina T. Yuan, Jill A. Marsteller, Susan M. Hannum, Elyse C. Lasser, JaAlah-Ai Heughan, Tyler Oberlander, Zackary D. Berger, Ayse P. Gurses, Hadi Kharrazi, Samantha I. Pitts, Sarah H. Scholle, Sydney M. Dy
The Journal of the American Board of Family Medicine Sep 2020, 33 (5) 754-764; DOI: 10.3122/jabfm.2020.05.200042

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Patient Safety in Primary Care: Conceptual Meanings to the Health Care Team and Patients
Alden Yuanhong Lai, Christina T. Yuan, Jill A. Marsteller, Susan M. Hannum, Elyse C. Lasser, JaAlah-Ai Heughan, Tyler Oberlander, Zackary D. Berger, Ayse P. Gurses, Hadi Kharrazi, Samantha I. Pitts, Sarah H. Scholle, Sydney M. Dy
The Journal of the American Board of Family Medicine Sep 2020, 33 (5) 754-764; DOI: 10.3122/jabfm.2020.05.200042
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Keywords

  • Administrative Personnel
  • Focus Groups
  • Patient Safety
  • Patient-Centered Care
  • Practice-Based Research
  • Primary Health Care
  • Qualitative Research
  • Referral and Consultation

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