PRIMARY CARE RESEARCH METHODS AND STATISTICS CONFERENCE

这项新的为期三年的研究由内布拉斯加州大学提交 医疗中心。拟议的研究的重点是发现 加强或抑制预防性服务交付的实践特征 在私人执业的家庭医生中提供服务。具体地说， 研究建议使用多方法人种学分析来检查 预防服务在初级保健实践中管理，因为 办公室实践的多种相互竞争的需求。拟议的研究 重点关注：1)检查支持以下内容的组织环境 预防性服务；2)审查在 预防与保健并举；3)方法比较 在预防服务中高强度与低强度的实践使用； 4)确定用于提供不同类型预防措施的方法 服务；以及5)描述评估指南的新方法 由AHCPR和其他政府和专业组织实施。 本研究采用对比案例研究设计，具有可复制性 后续行动。从100多个实践中提取的两个独立的实践池 参与以前的研究将构成以下方面的抽样框架 这项调查。第一阶段的分析将基于十个 将根据以下范围有目的地制定实践 初级保健实践中提供的预防性服务(高级别和低级别)。 这十个实践将通过集中的、定性的 一名研究护士花费多达八年的人种学方法 在几周的练习中收集数据。假设将会被生成 关于在这些机构中提供预防性服务的强度 初级保健实践。至少8项初级保健的额外样本 实习场将被用来证实或不证实假设 在案例研究调查的初始阶段生成，或 提出新的、可供选择的假设。 基本数据将基于研究护士的参与观察 参加实践活动，深入采访医生 和工作人员，以及重点关注的患者群体。研究的最终结果 将是一组18个深入的案例研究，描述以下策略 发展预防性服务，在相互竞争的需求范围内发挥作用 初级保健实践。 该项目的头两年将用于密集的数据 收集活动，第三年主要用于写作 18个案例研究。该项目将由本杰明博士指导 克拉布特里，内布拉斯加大学的医学人类学家 家庭医学部医学中心。该项目将包括 全国知名的顾问和外部咨询委员会，该委员会 旨在确保从不同的角度 学术和“现实世界”的初级保健实践。最后，独立 审核员将审查个别和比较案例研究，以确保 数据责任、评估方法质量、评审分析和 防止过度解读和解释差异。

This new three-year study is submitted by the University of Nebraska Medical Center. The focus of the proposed research is on discovering practice features that enhance or inhibit the delivery of preventive services among family physicians in private practice. Specifically, the study proposes to employ multimethod ethnographic analysis to examine how preventive services are managed in primary care practices in view of the multiple competing demands of office practice. The proposed research focuses on: 1) examining the organizational contexts that support preventive services; 2) examining the competing demands imposed in carrying out both prevention and illness care; 3) comparing approaches used by practices with high versus low intensity in preventive services; 4) identifying approaches used to deliver different types of preventive services; and 5) describing new methods for evaluating guidelines being implemented by AHCPR and other government and professional organizations. The study employs a comparative case study design with replicative follow-up. Two separate pools of practices drawn from over 100 practices participating in a pervious study will constitute the sampling frame for the investigation. The first phase of the analysis will be based on ten practices that will be purposefully drawn based on the extent of preventive services provided in the primary care practice (high and low). These ten practices will be examined through intensive, qualitative ethnographic methods in which a research nurse spends as much as eight weeks in the practice collecting data. Hypotheses will be generated regarding the intensity of delivery of preventive services among these primary care practices. An additional sample of at least 8 primary care practice sites will be used to confirm or disconfirm the hypotheses generated during the initial phase of the case study investigation or to develop new, alternative hypotheses. Primary data will be based on participant observation by research nurses participating in practice activities, in-depth interviews of physicians and staff, and focus groups of patients. The final product of the study will be a set of 18 in-depth case studies describing strategies to develop preventive services that work within the competing demands of primary care practice. The first two years of the project will be spent in intensive data collection activity, and the third year is largely devoted to writing up the 18 case studies. The project will be directed by Dr. Benjamin Crabtree, a medical anthropologist based at the University of Nebraska Medical Center, Department of Family Medicine. The project will include nationally know consultants and an external advisory committee which is designed to ensure representation of different perspectives from the academic and "real world" of primary care practice. Finally, independent auditors will review individual and comparative case studies to ensure data accountability, assess quality of methods, review analysis, and guard against overinterpretation and interpretive discrepancies.