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Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study
Amy E Binns-Calvey1, Alex Malhiot, Carol T Kostovich
1A.E. Binns-Calvey is project manager, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and research specialist, University of Illinois at Chicago, Chicago, Illinois. A. Malhiot is qualitative project manager, C+R Research, Chicago, Illinois. C.T. Kostovich is research health scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and associate professor and director of simulation, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. S.L. LaVela is research scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and research assistant professor, Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. K. Stroupe is research health scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and associate professor, Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. B.S. Gerber is professor of medicine, Division of Academic Internal Medicine and Geriatrics, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. L. Burkhart is research scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and associate professor, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. S.J. Weiner is deputy director, Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Medical Center, Chicago, Illinois, and professor of medicine, pediatrics and medical education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. F.M. Weaver is director, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and professor, Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
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.
