Connecting the Dots and Merging Meaning: Using Mixed Methods to Study Primary Care Delivery Transformation

Authors

  • Debra L. Scammon,

    Corresponding author
    1. David Eccles School of Business, University of Utah, Salt Lake City, UT
    2. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
    • Address correspondence to Debra L. Scammon, Ph.D., David Eccles School of Business, University of Utah 1655 Campus Center Dr, Room 1113, Salt Lake City, UT 84112; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT; e-mail: debra.scammon@business.utah.edu.

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    • Sharing lead authorship.
  • Andrada Tomoaia-Cotisel,

    1. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
    2. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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    • Sharing lead authorship.
  • Rachel L. Day,

    1. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
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  • Julie Day,

    1. Community Clinics, University of Utah Hospitals and Clinics, University of Utah, Salt Lake City, UT
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  • Jaewhan Kim,

    1. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
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  • Norman J. Waitzman,

    1. Department of Economics, University of Utah, Salt Lake City, UT
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  • Timothy W. Farrell,

    1. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
    2. Division of Geriatrics, University of Utah, Salt Lake City, UT
    3. VA SLC Geriatric Research, Education and Clinical Center, Salt Lake City, UT
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  • Michael K. Magill

    1. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
    2. University of Utah Health Plans, Salt Lake City, UT
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Abstract

Objective

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.

Study Design

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.

Principal Findings

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.

Conclusions

Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence.

Ancillary