Table 2.

Examples of Key Findings by Step in the Primary Care Process

	Previsit	Visit			Postvisit
Key Finding	Scheduling Appointments	Check-in	Rooming	Clinician Visit	Laboratory and Imaging
Information flow	Reason for visit not always clearly communicated or understood, leading to patients getting visit scheduled for something that could have been dealt with over the telephone	Changes to addresses or insurance information need to be updated in multiple places	Problems identified by MAs during screening not always seen by physician	Medication lists frequently not reconciled appropriately because patients assume the computer is correct	Laboratory orders not entered correctly or did not print, which causes confusion or errors when patient goes to laboratory
Alignment of goals and expectations	Open-access scheduling can conflict with patient’s need to be able to plan ahead	Patients frustrated with not being seen when late, even when public transportation issues were the cause	MAs caught between need to keep flow moving and increasing number of screening questions they are expected to ask	Patients have multiple concerns, and clinicians may be willing to address only 1 or 2 or prioritize chronic disease management	Prior authorization requirements of insurance companies conflict with patient and clinician desire for rapid access to needed tests
Personal relationships	Knowing which patients will have trouble scheduling follow-up can help care coordinators decide whom to schedule in advance	Patients feel comfortable with front desk staff whom they have known for many years	Patients more likely to discuss true reason for visit with staff they know well	Trust between patients and clinicians develops with time	Walking patients to laboratory prevents them from leaving before having tests completed

MA=medical assistant.