Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study Conducted at Chicago Area Veterans Health Administration Sites

Amy E. Binns-Calvey*, Alex Malhiot, Carol T. Kostovich, Sherri L. LaVela, Kevin Stroupe, Ben S. Gerber, Lisa Burkhart, Saul J. Weiner, Frances M. Weaver

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Purpose "Patient context" indicates patient circumstances and characteristics or states that are essential to address when planning patient care. Specific patient "contextual factors," if overlooked, result in an inappropriate plan of care, a medical error termed a "contextual error." The myriad contextual factors that constitute patient context have been grouped into broad domains to create a taxonomy of challenges to consider when planning care. This study sought to validate a previously identified list of contextual domains. Method This qualitative study used directed content analysis. In 2014, 19 Department of Veterans Affairs (VA) providers (84% female) and 49 patients (86% male) from two VA medical centers and four outpatient clinics in the Chicago area participated in semistructured interviews and focus groups. Topics included patient-specific, community, and resource-related factors that affect patients' abilities to manage their care. Transcripts were analyzed with a previously identified list of contextual domains as a framework. Results Analysis of responses revealed that patients and providers identified the same 10 domains previously published, plus 3 additional ones. Based on comments made by patients and providers, the authors created a revised list of 12 domains from themes that emerged. Six pertain to patient circumstances such as access to care and financial situation, and 6 to patient characteristics/states including skills, abilities, and knowledge. Conclusions Contextual factors in patients' lives may be essential to address for effective care planning. The rubric developed can serve as a "contextual differential" for clinicians to consider when addressing challenges patients face when planning their care.

Original languageEnglish (US)
Pages (from-to)1287-1293
Number of pages7
JournalAcademic Medicine
Volume92
Issue number9
DOIs
StatePublished - Sep 1 2017

ASJC Scopus subject areas

  • Education

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