Table t1.

Research Challenges, by Intervention Level

SYSTEM

Documentation of Administrative Patient Data (IS) Unreliable contact information Unreliable or missing race data Missing language-preference data Inconsistent coding of visit type (e.g., health maintenance, follow-up, urgent care)

Medical Records Data Lack of electronic medical records Difficulty locating records Poor system for tracking down records Poor distinction of patient and visit type (e.g., primary care or urgent care only) Inconsistent organization, including documentation of a problem list, documentation of referrals

Scheduling: Time restrictions for individual visits

Staffing Largely by Residents Lack of continuity for patient over time Each resident sees few patients Turnover requires ongoing orientation and training Competing educational and clinical demands limits research participation

PCP/Specialist Communication Incomplete or missing documentation of orders Inconsistent reporting or documentation of results PCPs often rely on patients for reports Varying reports about who is responsible for follow-up and surveillance

Size and Catchment Area: Often serve small numbers of patients

PROVIDER (KII, PS)

Perceptions of Patients: Often inaccurately perceive patient as not interested in prevention and early detection

Competing Demands Lack of clerical and nursing support limits time for research participation Research often not perceived as part of role

Counseling and Referral Skills Lack of awareness of coverage and specialist’s procedures Perception of own counseling as ineffective, particularly given time restrictions for visits

PATIENT (AAFG, AAPS, HKII, HFG)

Competing Priorities High levels of comorbidity High levels of poverty

Among African Americans, Issues of Mistrust Mistrust of medical care system in general, but not of personal PCPs Mistrust of residents in general, but not of personal PCPs

Lack of Transportation: Difficulty coming to the clinic to participate in study Among Hispanics, Inability to Communicate Effectively Communication challenges persist even with Spanish-speaking staff Poor show rates and confusion regarding study purpose, even with multiple reminders

Note. IS = information systems database; PCP = primary care provider; KII = key informant interviews; PS = provider surveys; AAFG = African American focus groups; AAPS = African American patient telephone surveys; HKII = Hispanic key informant interviews; HFG = Hispanic focus groups.