• Bethany M Kwan, Douglas Fernald, Peter Ferrarone, Natalia Loskutova, Jodi Summers Holtrop, Elizabeth W Staton, and John M Westfall.
• From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (BMK, DF, PF, JSH, EWS, JMW); American Academy of Family Physicians National Research Network, Leawood, KS (NL). bethany.kwan@ucdenver.edu.
• J Am Board Fam Med. 2019 Mar 1; 32 (2): 136-145.

PurposeThe purpose of this project was to evaluate the real-world usability and usefulness of a revised version of the published Agency for Healthcare Research and Quality "Improving Your Office Testing Process" toolkit, designed to help primary care practices standardize and systematize laboratory testing processes.MethodWe used a multiple case study approach to evaluate toolkit implementation in 2 primary care practices with existing quality improvement (QI) infrastructure. We collected qualitative data at baseline, midpoint (3 to 4 weeks), and follow-up (7 to 8 weeks postimplementation). Data included key informant interviews and practice site observations. Nineteen clinicians and staff participated in the interviews. Thematic analysis was used to summarize (1) how practices used the toolkit for guiding lab testing process improvement (usefulness), and (2) ease of use and practice experience with using the toolkit (usability).ResultsThe toolkit was perceived as easy to use and easy to follow step by step. Two components of the toolkit were particularly useful: guidance on data gathering to inform quality improvement and tools for effective practice-patient communication. The toolkit's practice and patient assessments facilitated practice-specific insights into the lab processes considered most harmful to patients and informed improvement activities.ConclusionThe usability and usefulness of the toolkit were related to the characteristics of the toolkit itself (adaptability, simplicity, and design quality and packaging, and guidance in planning) and practice processes (presence of practice champions and implementation teams). In a set of 2 practices in which laboratory testing process improvement was a high priority and where well-established QI infrastructure exists, the toolkit was easy to use with little technical assistance.© Copyright 2019 by the American Board of Family Medicine.

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