Objective. To provide practical strategies for conducting and evaluating analyses of qualitative data applicable for health services researchers. Data Sources and Design. We draw on extant qualitative methodological literature to describe practical approaches to qualitative data analysis. Approaches to data analysis vary by discipline and analytic tradition; however, we focus on qualitative data analysis that has as a goal the generation of taxonomy, themes, and theory germane to health services research. Principle Findings. We describe an approach to qualitative data analysis that applies the principles of inductive reasoning while also employing predetermined code types to guide data analysis and interpretation. These code types (conceptual, relationship, perspective, participant characteristics, and setting codes) define a structure that is appropriate for generation of taxonomy, themes, and theory. Conceptual codes and subcodes facilitate the development of taxonomies. Relationship and perspective codes facilitate the development of themes and theory. Intersectional analyses with data coded for participant characteristics and setting codes can facilitate comparative analyses. Conclusions. Qualitative inquiry can improve the description and explanation of complex, real-world phenomena pertinent to health services research. Greater understanding of the processes of qualitative data analysis can be helpful for health services researchers as they use these methods themselves or collaborate with qualitative researchers from a wide range of disciplines.Key Words. Qualitative methods, taxonomy, theme development, theory generation Qualitative research is increasingly common in health services research (Shortell 1999;Sofaer 1999). Qualitative studies have been used, for example, to study culture change (Marshall et al.

Advance care planning should take into account patients' attitudes toward the burden of treatment, the possible outcomes, and their likelihood. The likelihood of adverse functional and cognitive outcomes of treatment requires explicit consideration.

O utcomes research examines the effects of medical care interventions and policies on the health outcomes of individuals and society. 1 Investigators conducting outcomes research seek to inform the development of clinical practice guidelines, to evaluate the quality of medical care, and to foster effective interventions to improve the quality of care. 2 Outcomes research has traditionally used quantitative sciences to examine the utilization, cost, and clinical effectiveness of medical care through randomized and nonrandomized experimental designs. Quantitative methods are not as well suited to measure other complex aspects of the healthcare delivery system, such as organizational change, clinical leadership in implementing evidence-based guidelines, and patient perceptions of quality of care, which are also critical issues in outcomes research. [3][4][5][6][7] These more nuanced aspects of healthcare delivery may be most appropriately examined with qualitative research methods. 8 -10 Qualitative approaches are becoming more common in clinical medicine and health services research. 5,[11][12][13][14][15] Federal encouragement of qualitative research is regularly reflected in funding program announcements issued by the National Institutes of Health. 16 For more than a decade, federal agencies and foundations such as the National Science Foundation have demonstrated a commitment to supporting qualitative research through funding scientific conferences, workshops, and monographs on this field of inquiry. [17][18][19][20] Despite this steady growth in qualitative research, outcomes investigators in cardiology have relatively little guidance on when and how best to implement these methods in their investigations.The purpose of the present report is to introduce qualitative methods as providing unique and critical contributions to outcomes research. This report will describe the situations in which qualitative approaches are most helpful; summarize the primary principles and practices in study design, sampling, data collection, and data analysis for qualitative studies; present representative examples of cardiovascular outcomes research that uses qualitative methods; and synthesize current standards for ensuring rigor and enhancing credibility of qualitative research. Defining Qualitative ResearchQualitative research is a form of scientific inquiry that spans different disciplines, fields, and subject matter and comprises many varied approaches. 21 Qualitative methods can be used to understand complex social processes, to capture essential aspects of a phenomenon from the perspective of study participants, 5 and to uncover beliefs, values, and motivations that underlie individual health behaviors. [22][23][24] Such research can also illuminate aspects of organizational context and healthcare delivery that influence organizational performance and quality of care. 10,25 Qualitative studies are often exploratory in nature and seek to generate novel insights 9,23,26,27 using inductive (starting with observations and dev...

Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation.

Time to primary PCI is strongly associated with mortality risk and is important regardless of time from symptom onset to presentation and regardless of baseline risk of mortality. Efforts to shorten door-to-balloon time should apply to all patients.

BackgroundDespite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality.MethodsWe synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction.ResultsThe positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.ConclusionThe identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

Background-In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF

BackgroundPhysician leadership development programs typically aim to strengthen physicians’ leadership competencies and improve organizational performance. We conducted a systematic review of medical literature on physician leadership development programs in order to characterize the setting, educational content, teaching methods, and learning outcomes achieved.MethodsArticles were identified through a search in Ovid MEDLINE from 1950 through November 2013. We included articles that described programs designed to expose physicians to leadership concepts, outlined teaching methods, and reported evaluation outcomes. A thematic analysis was conducted using a structured data entry form with categories for setting/target group, educational content, format, type of evaluation and outcomes.ResultsWe identified 45 studies that met eligibility criteria, of which 35 reported on programs exclusively targeting physicians. The majority of programs focused on skills training and technical and conceptual knowledge, while fewer programs focused on personal growth and awareness. Half of the studies used pre/post intervention designs, and four studies used a comparison group. Positive outcomes were reported in all studies, although the majority of studies relied on learner satisfaction scores and self-assessed knowledge or behavioral change. Only six studies documented favorable organizational outcomes, such as improvement in quality indicators for disease management. The leadership programs examined in these studies were characterized by the use of multiple learning methods, including lectures, seminars, group work, and action learning projects in multidisciplinary teams.DiscussionPhysician leadership development programs are associated with increased self-assessed knowledge and expertise; however, few studies have examined outcomes at a system level. Our synthesis of the literature suggests important gaps, including a lack of programs that integrate non-physician and physician professionals, limited use of more interactive learning and feedback to develop greater self-awareness, and an overly narrow focus on individual-level rather than system-level outcomes.