Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation.
Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation.
复制标题
连接点并融合意义：使用混合方法研究初级保健提供转型。
DOI：
10.1111/1475-6773.12114
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发表时间：
2013
影响因子：
3.4
通讯作者：
Magill,MichaelK
中科院分区：
文献类型：
--
作者：
Scammon,DebraL;Tomoaia-Cotisel,Andrada;Day,RachelL;Day,Julie;Kim,Jaewhan;Waitzman,NormanJ;Farrell,TimothyW;Magill,MichaelK
目标。论证混合方法在实践转化研究中的价值，并说明连接方法和合并结果以增强派生意义的程序。数据源/研究设置。犹他大学(社区诊所或CCS)大学拥有的初级保健实践的综合网络。CC已经采用了其以患者为中心的医疗之家的版本--设计关怀。研究设计。融合案例研究，混合方法设计。数据收集/提取方法。分析档案文件、内部业务报告、临床观察、图表审计、调查、半结构化访谈、焦点小组、医疗保险和医疗补助服务中心数据库以及犹他州所有付款人索赔数据库。主要发现。每个数据来源都丰富了我们对变化过程的了解，以及对某些变化比其他变化更难的原因的理解，无论是在一般情况下还是对特定的诊所来说。混合方法能够生成和测试关于变化的假设，并导致对实践变化的全面理解。结论。混合方法在实践转化研究中是有用的。挑战是存在的，但通过仔细的规划和坚持不懈的努力是可以克服的。
Objective. To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. Data Source/Study Setting. An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. Study Design. Convergent case study mixed methods design. Data Collection/Extraction Methods. Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. Principal Findings. Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Conclusions. Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence.