Sharing lead authorship.
Integrating Mixed Methods in Health Services and Delivery System Research
Connecting the Dots and Merging Meaning: Using Mixed Methods to Study Primary Care Delivery Transformation
Article first published online: 1 NOV 2013
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 6pt2, pages 2181–2207, December 2013
How to Cite
Scammon, D. L., Tomoaia-Cotisel, A., Day, R. L., Day, J., Kim, J., Waitzman, N. J., Farrell, T. W. and Magill, M. K. (2013), Connecting the Dots and Merging Meaning: Using Mixed Methods to Study Primary Care Delivery Transformation. Health Services Research, 48: 2181–2207. doi: 10.1111/1475-6773.12114
- Issue published online: 26 NOV 2013
- Article first published online: 1 NOV 2013
- Manuscript Accepted: 28 JUL 2013
- Agency for Health care Research and Quality. Grant Number: R18HS019136
- Practice transformation;
- patient centered medical home;
- mixed methods;
- primary care
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.
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.
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.
Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence.