Assessing Diversity and Quality in Primary Care Through the Multimethod Assessment Process (MAP)

Kairys, Jo Ann; Orzano, John; Gregory, Patrice M.; Stroebel, Christine; DiCicco-Bloom, Barbara; Roemheld-Hamm, Beatrix; Kobylarz, Fred; Scott, Jewel; Coppola, Lisa; Crabtree, Benjamin F.

doi:10.1097/00019514-200210040-00004

Cited by 22 publications

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“…That is, the case study strategy could be the appropriate approach for exploratory, descriptive, or explanatory purposes. Recently, Kairys et al (2002) used the case method for purposes of explanation and in the same study for actively changing medical practices in a form of participatory research. The literature contains examples of case study being used for each of these levels of knowledge development.…”

Section: Discussionmentioning

confidence: 99%

Case Study Research: The View From Complexity Science

et al. 2005

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Many wonder why there has been so little change in care quality, despite substantial quality improvement efforts. Questioning why current approaches are not making true changes draws attention to the organization as a source of answers. We bring together the case study method and complexity science to suggest new ways to study health care organizations. The case study provides a method for studying systems. Complexity theory suggests that keys to understanding the system are contained in patterns of relationships and interactions among the system's agents. We propose some of the "objects" of study that are implicated by complexity theory and discuss how studying these using case methods may provide useful maps of the system. We offer complexity theory, partnered with case study method, as a place to begin the daunting task of studying a system as an integrated whole. KeywordsCase study methods; research; complexity science; health care organizations Dr. Jane Russell, Family Physician, spoke at a luncheon with great zeal about the benefits of preventive medicine, transferring her enthusiasm to the audience of family health care providers. It was evident that the individuals in this group felt strongly about the value of prevention as a part of their medical practice. When we examined Dr. Russell's practice for the level of preventive services delivered, therefore, we were greatly surprised to find that, while most women in her practice were up-to-date with mammograms, in only 10% of her patients who smoked tobacco was there any documentation of their ever having been counseled to stop smoking.In order to understand and improve the complex contexts and interactions that lead to anomalies such as those presented by Dr. Russell, theoretical models and research methods are needed for understanding health care organizations. These models and methods need to address questions such as: "Why have we seen so little change in what is being done for clients despite substantial knowledge in the form of best practice guidelines?" "Why is it that a physician, NIH Public Access

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Section: Discussionmentioning

confidence: 99%

Case Study Research: The View From Complexity Science

et al. 2005

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“…A growing body of qualitative research characterizes the diversity and complexity of primary care offices, in particular by combining multifaceted data collection techniques such as direct observation, interviews, and extensive documentation of relationships across different office personnel [38]. However, there has been little quantitative evaluation of office-level organizational features [39-41], particularly with respect to depression care.…”

Section: Methodsmentioning

confidence: 99%

Organizational factors and depression management in community-based primary care settings

et al. 2009

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BackgroundEvidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework.MethodsWe used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance).ResultsThe results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment.ConclusionsThe primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.

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“…Prior to the first practice team meeting, the facilitators will conduct a one-week detailed assessment in each of the 20 intervention practices [31-33]. This data will be used to prepare an initial practice report that will be used in the first step of the intervention.…”

Section: Methodsmentioning

confidence: 99%

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

et al. 2008

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Background: Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids -three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.

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Assessing Diversity and Quality in Primary Care Through the Multimethod Assessment Process (MAP)

Cited by 22 publications

References 0 publications

Case Study Research: The View From Complexity Science

Case Study Research: The View From Complexity Science

Organizational factors and depression management in community-based primary care settings

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

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