PRIMARY CARE RESEARCH METHODS AND STATISTICS CONFERENCE

这项为期三年的新研究由内布拉斯加大学提交， 医学中心拟议研究的重点是发现 增强或抑制预防性治疗的实践特征 在私人执业的家庭医生中提供服务。具体而言是 一项研究建议采用多方法民族志分析来研究如何 预防性服务在初级保健实践中进行管理， 办公室实践的多种竞争需求。 拟议研究 重点是：1）检查支持的组织背景 预防性服务; 2）审查在 预防与保健并举; 3）比较方法 在预防服务的高强度和低强度实践中使用; 4)确定用于提供不同类型的预防措施的方法 服务;和5）描述评估指南的新方法， 由AHCPR和其他政府和专业组织执行。 本研究采用了比较案例研究设计， 随访从100多个实践中提取的两个独立的实践池 参与先前的研究将构成抽样框架， 调查第一阶段的分析将基于十个 将有目的地根据程度绘制的做法， 在初级保健实践中提供的预防性服务（高和低）。 这十种做法将通过密集的，定性的 一个研究护士花了八个月的时间 在实践中收集数据。将生成假设 关于在这些人中提供预防服务的强度， 初级保健实践。至少8个初级保健的额外样本 实践现场将被用来证实或否定的假设 在案例研究调查的初始阶段产生的，或 提出新的替代假设。 主要数据将基于研究护士的参与观察 参与实践活动，深入访谈医师 和工作人员，以及病人的焦点小组。 研究的最终产品 将是一组18个深入的案例研究，描述策略， 发展预防性服务，满足以下方面的竞争需求： 初级保健实践。 该项目的前两年将用于密集的数据 收集活动，第三年主要是致力于写作 18个案例研究该项目将由本杰明博士指导 内布拉斯加大学的医学人类学家克拉布特里说， 家庭医学部医学中心。该项目将包括 全国知名的顾问和一个外部咨询委员会， 旨在确保代表不同的观点， 学术和“真实的世界”的初级保健实践。最后，独立 审计员将审查个别和比较案例研究，以确保 数据问责制，评估方法的质量，审查分析， 防止过度解释和解释上的差异。

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.