Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake

Allison A Lewinski, Matthew J Crowley, Christopher Miller, Hayden B Bosworth, George L Jackson, Karen Steinhauser, Courtney White-Clark, Felicia McCant, Leah L Zullig, Allison A Lewinski, Matthew J Crowley, Christopher Miller, Hayden B Bosworth, George L Jackson, Karen Steinhauser, Courtney White-Clark, Felicia McCant, Leah L Zullig

Abstract

Background: Rapid approaches to collecting and analyzing qualitative interview data can accelerate discovery timelines and intervention development while maintaining scientific rigor. We describe the application of these methods to a program designed to improve care coordination between the Veterans Health Administration (VHA) and community providers.

Methods: Care coordination between VHA and community providers can be challenging in rural areas. The Telehealth-based Coordination of Non-VHA Care (TECNO Care) intervention was designed to improve care coordination among VHA and community providers. To ensure contextually appropriate implementation of TECNO Care, we conducted preimplementation interviews with veterans, VHA administrators, and VHA and community providers involved in community care. Using both a rapid approach and qualitative analysis, an interviewer and 1-2 note-taker(s) conducted interviews.

Results: Over 5 months, 18 stakeholders were interviewed and we analyzed these data to identify how best to deliver TECNO Care. Responses relevant to improving care coordination include health system characteristics; target population; metrics and outcomes; challenges with the current system; and core components. Veterans who frequently visit VHA or community providers and are referred for additional services are at risk for poor outcomes and may benefit from additional care coordination. Using these data, we designed TECNO Care to include information on VHA services and processes, assist in the timely completion of referrals, and facilitate record sharing.

Conclusion: Rapid qualitative analysis can inform near real-time intervention development and ensure relevant content creation while setting the stage for stakeholder buy-in. Rigorous and timely analyses support the delivery of contextually appropriate, efficient, high-value patient care.

Conflict of interest statement

H.B.B. reports receiving research funds from Sanofi, Otsuka, Johnson and Johnson, Improved Patient Outcomes, Novo Nordisk, PhRMA Foundation as well as consulting funds from Sanofi, Otsuka, Abbott, and Novartis. L.L.Z. reports receiving funding from the PhRMA Foundation and Proteus Digital Health as well as consulting funds from Novartis. A.A.L. reports receiving funding from Otsuka and the PhRMA Foundation. The remaining authors declare no conflicts of interest.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1
FIGURE 1
Conceptual framework of TECNO Care intervention. TECNO Care indicates Telehealth-based Coordination of Non-VHA Care; VHA, Veterans Health Administration.
FIGURE 2
FIGURE 2
Timeline of activities from month 1 through month 5. VHA indicates Veterans Health Administration.

References

    1. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009;374:86–89.
    1. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform. 2000;1:65–70.
    1. Hanney SR, Castle-Clarke S, Grant J, et al. . How long does biomedical research take? Studying the time taken between biomedical and health research and its translation into products, policy, and practice. Health Res Policy Syst. 2015;13:1.
    1. Bauer MS, Kirchner J. Implementation science: what is it and why should I care? Psychiatry Res. 2019;283:112376.
    1. Gale RC, Wu J, Erhardt T, et al. . Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implement Sci. 2019;14:11.
    1. Taylor B, Henshall C, Kenyon S, et al. . Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? A mixed methods study comparing rapid and thematic analysis. BMJ Open. 2018;8:e019993.
    1. Watkins DC. Rapid and rigorous qualitative data analysis: the “RADaR” technique for applied research. Int J Qual Methods. 2017;16:1609406917712131.
    1. Brown-Johnson C, Safaeinili N, Zionts D, et al. . The Stanford Lightning Report Method: a comparison of rapid qualitative synthesis results across four implementation evaluations. Learn Health Syst. 2020;4:e10210.
    1. Hamilton AB. Qualitative methods in rapid turn-around health services research. Health Services Research & Development Cyberseminar. 2013. Available at: . Accessed August 16, 2020.
    1. Vindrola-Padros C, Vindrola-Padros B. Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery. BMJ Qual Saf. 2018;27:321–330.
    1. Forrest CB, Chesley FD, Jr, Tregear ML, et al. . Development of the learning health system researcher core competencies. Health Serv Res. 2018;53:2615–2632.
    1. Atkins D, Kilbourne AM, Shulkin D. Moving from discovery to system-wide change: the role of research in a learning health care system: experience from three decades of health systems research in the Veterans Health Administration. Annu Rev Public Health. 2017;38:467–487.
    1. Kilbourne AM, Elwy AR, Sales AE, et al. . Accelerating research impact in a learning health care system: VA’s Quality Enhancement Research Initiative in the Choice Act Era. Med Care. 2017;55(suppl 7 suppl 1):S4–S12.
    1. Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014, H.R. 3230, 113th Cong. 2014. Available at: . Accessed August 16, 2020.
    1. Gellad WF. The Veterans Choice Act and dual health system use. J Gen Intern Med. 2016;31:153–154.
    1. Jones AL, Fine MJ, Stone RA, et al. . Veteran satisfaction with early experiences of health care through the Veterans Choice Program: a concurrent mixed methods study. J Gen Intern Med. 2019;34:1925–1933.
    1. Tsai J, Yakovchenko V, Jones N, et al. . “Where’s My Choice?” An examination of Veteran and provider experiences with hepatitis C treatment through the Veteran Affairs Choice Program. Med Care. 2017;55(suppl 7 suppl 1):S13–S19.
    1. Stroupe KT, Martinez R, Hogan TP, et al. . Experiences with the Veterans’ Choice Program. J Gen Intern Med. 2019;34:2141–2149.
    1. Nevedal AL, Wagner TH, Ellerbe LS, et al. . A qualitative study of primary care providers’ experiences with the Veterans Choice Program. J Gen Intern Med. 2019;34:598–603.
    1. Zuchowski JL, Chrystal JG, Hamilton AB, et al. . Coordinating care across health care systems for veterans with gynecologic malignancies: a qualitative analysis. Med Care. 2017;55(suppl 7 suppl 1):S53–S60.
    1. US Department of Veterans Affairs. VA MISSION Act; 2019. Available at: . Accessed November 13, 2019.
    1. Damschroder LJ, Aron DC, Keith RE, et al. . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.
    1. Darkins A, Ryan P, Kobb R, et al. . Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health. 2008;14:1118–1126.
    1. US Department of Veterans Affairs. VA Telehealth; 2020. Available at: . Accessed August 25, 2020.
    1. Gale NK, Heath G, Cameron E, et al. . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.
    1. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.
    1. Averill JB. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res. 2002;12:855–866.
    1. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26:1753–1760.
    1. Hamilton AB, Finley EP. Reprint of: Qualitative methods in implementation research: an introduction. Psychiatry Res. 2020;283:112629.
    1. Finley EP, Huynh AK, Farmer MM, et al. . Periodic reflections: a method of guided discussions for documenting implementation phenomena. BMC Med Res Methodol. 2018;18:153.
    1. Palinkas LA, Mendon SJ, Hamilton AB. Innovations in mixed methods evaluations. Annu Rev Public Health. 2019;40:423–442.
    1. Guerrero EG, Hahn EE, Khachikian T, et al. . Interdisciplinary dissemination and implementation research to advance translational science: challenges and opportunities. J Clin Transl Sci. 2017;1:67–72.
    1. Hamilton AB, Brunner J, Cain C, et al. . Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women’s health primary care. Transl Behav Med. 2017;7:478–485.
    1. Davis K, Minckas N, Bond V, et al. . Beyond interviews and focus groups: a framework for integrating innovative qualitative methods into randomised controlled trials of complex public health interventions. Trials. 2019;20:329–329.

Source: PubMed

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