The critical role of qualitative and mixed methodologies in understanding PACT implementation

Solimeo SL, Forman J, True G, Tuepker A, Hamilton A. The critical role of qualitative and mixed methodologies in understanding PACT implementation. Presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.

Workshop Objectives: This workshop demonstrates the critical role of qualitative and mixed methodologies in understanding the barriers to and facilitators of Patient Aligned Care Team (PACT) implementation in primary care. Presenters are lead qualitative investigators on the national PACT Demonstration Laboratories who are actively engaged in formative evaluation, interventions, and ethnographic research. As such, their work represents part of a comprehensive national effort to assess and understand the development of best practices by drawing on the perspectives of key stakeholders ranging from frontline clerical assistants to VISN leadership. PACT implementation is both a cultural and organizational transformation. Quantitative performance measures and patient outcomes are central to evaluating PACT's impact on primary care, however qualitatively-derived data provide on-the-ground perspectives that explain quantitative trends. Methodologies that engage a variety of stakeholder experiences can effectively: signal implementation hotspots in need of additional staffing, space, management attention, or other resources; identify emerging innovations at the teamlet, team, or clinic level for broader diffusion; provide a safeguarded mechanism for primary care staff to communicate needs; help explain data quality or other anomalies by observing reporting, workflow, or other practices; and assess and augment ongoing training needs. Timely findings like these fuel a cycle of more robust partnership between research, clinical, and administrative staff. Activities: The workshop begins with an overview of the purpose of the PACT Demonstration Laboratories and the ways in which qualitative methodologies fulfill their objectives (VISN 23). Four case presentations follow and demonstrate how qualitative methodologies address research questions, report on qualitative findings, and explain the role of these findings in improving PACT implementation (VISNs 4, 11, 20, and 23). Key themes from the case presentations will be synthesized and the significance of mixed methodologies discussed by a final presentation (VISN 22). Audience members are encouraged to participate through open dialogue and a closing question and answer session. Target Audience: The workshop is useful for two groups: 1) clinicians or primary care leaders seeking to understand the challenges faced by staff implementing PACT, and 2) HSRandD researchers and project staff interested in the role of qualitative methodologies in implementation science. Assumed Audience Familiarity with Topic: A basic understanding of the PACT model.