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

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1097/mlr.0000000000001553

Publication Info

Lewinski, Allison A, Matthew J Crowley, Christopher Miller, Hayden B Bosworth, George L Jackson, Karen Steinhauser, Courtney White-Clark, Felicia McCant, et al. (2021). Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake. Medical care, 59(Suppl 3). pp. S242–S251. 10.1097/mlr.0000000000001553 Retrieved from https://hdl.handle.net/10161/29640.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Lewinski

Allison A. Lewinski

Assistant Research Professor in the School of Nursing

As a nurse scientist and health services researcher, with a joint appointment between the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA), I have acquired expertise in the areas of diabetes distress, qualitative research methods, and virtual care (e.g., telehealth, digital health) as a method of care delivery. My research focuses on the current and potential ability of virtual care interventions to reduce distress, improve self-management, increase access to evidence-based care delivery, and improve patient and population health outcomes. My collaborative and interdisciplinary research focuses on how patient-, provider-, and system-level factors influence virtual care use and outcomes. As evidence of its growing significance and impact at DUSON and the VHA, my work has been well funded, published in high-impact journals, presented at select conferences, and used to guide health system decision-making. I am a sought-after teacher and mentor because I connect my research interests to teaching students and mentees rigorous and systematic research approaches. I am frequently asked by local and national colleagues to provide guidance on distress, qualitative research methods, and virtual care approaches used in grants, projects, and manuscripts.  

My research contributions have focused on alleviating psychosocial distress, developing and implementing multi-level virtual care interventions, and enhancing qualitative methods. As a staff nurse, I witnessed the psychosocial distress of patients who experience challenges in obtaining care which led to my interest in diabetes distress. I aspire and work to improve health outcomes for individuals with chronic illness by developing equitable and sustainable multi-level virtual care interventions and assessing their implementation and adaptation. Virtual care describes any remote interaction between a patient and/or members of their care team. To achieve these goals, I use qualitative methods and implementation science approaches to enhance alignment between patient, modality, disease state, and social and environmental context; my collective assessments address for whom and what purposes, in what situations and contexts, when in a disease course or clinical activity, and in what specific ways such interventions are effective. My focus on the uptake and adoption of virtual care to address psychosocial distress considers interactions with patients, between patients and clinicians, and within health care systems and the larger population.

Crowley

Matthew Janik Crowley

Associate Professor of Medicine

Diabetes, Hypertension, Health Services Research

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Jackson

George Lee Jackson

Adjunct Professor in Population Health Sciences

Areas of expertise: Epidemiology, Health Services Research, and Implementation Science

George L. Jackson, Ph.D., MHA is a healthcare epidemiologist and implementation scientist with a background in health administration.  He joined the faculty of the UT Southwestern Medical Center in February of 2023 as a Professor and Director of the Advancing Implementation & Improvement Science Program in the Peter O'Donnell Jr. School of Public Health.  Dr. Jackson is also a Veterans Affairs (VA) Health Services Research & Development (HSR&D) Research Health Scientist who works with the VA healthcare systems in both Durham, NC and Dallas, TX.  He is the Director of the Implementation and Improvement Science Lab/Core at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).  Additionally, he is a co-leader of a cooperative effort between the Dallas VA and Program on Implementation and Improvement Science designed to enhance the infrastructure for partnered health services and other research across the Dallas VA and UT Southwestern focused on enhancing the health and healthcare of Veterans in North Texas and across the Nation.

The UT Southwestern Advancing Implementation & Improvement Science Program seeks to further enhance collaborations between the UT Southwestern and affiliated health systems and community partners in the pursuit of common missions to enhance the health and healthcare of the people of North Texas.  The goal is to develop a system to identify potentially successful projects using implementation and improvement science – which uses rigorous, data-driven research to expand programs and improve a community’s health.

Dr. Jackson’s own research and evaluation efforts focus on the development, testing, and implementation of team-based approaches to address the treatment and prevention of chronic conditions such as diabetes, hypertension, and cancer.  He has also evaluated efforts to enhance the organization of mental health care.  As an implementation scientist, Dr. Jackson studies strategies focused on the adoption and spread of evidence-informed practices across large health systems.  He is currently the corresponding principal investigator for two VA program grants focused on the process of identifying, replicating, and spreading innovations across large healthcare systems.  These include the Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) partnered evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence program and the Dynamic Diffusion Network (DDN) QUERI Program, both funded by the VA Quality Enhancement Research Initiative (QUERI).

Dr. Jackson received his Doctor of Philosophy (Ph.D.) in epidemiology, Master of Health Administration (MHA), and Bachelor of Science in Public Health (BSPH) in health policy and administration degrees from the School of Public Health at the University of North Carolina at Chapel Hill.  He completed an Agency for Healthcare Research and Quality (AHRQ) pre-doctoral fellowship in health services research at the Cecil G. Sheps Center for Health Services Research and AHRQ post-doctoral fellowship in health services research in the Duke Division of General Internal Medicine and HSR&D Center at the Durham VA.  He came to UT Southwestern from Duke University, where he was a Professor in the Departments of Population Health Sciences, Medicine (Division of General Internal Medicine), and Family Medicine & Community Health.  He also co-taught evidence-based practice in the Duke Physician Assistant (PA) Program.  Dr. Jackson currently maintains appointments as an Adjunct Professor of Population Health Sciences at Duke and Adjunct Professor of Health Policy and Management at the University of North Carolina at Chapel Hill.

Steinhauser

Karen E. Steinhauser

Professor in Population Health Sciences

Dr. Steinhauser's primary interests are end-of-life care, medical sociology and patient-provider relationships. Specifically, she investigates the composition and measurement of the quality of life for patients and their families at the end of life. Dr. Steinhauser is a Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham; Professor, Department of Population Health Science and Medicine; Senior Fellow with the Duke University Center for Aging; Associate Chief for Research, Duke Palliative Care, and Director, Duke Residency Professional Development Coaching Program. 

Karen E. Steinhauser, PhD is a social scientist dedicated to improving quality of life of patients, families, and providers during serious illness.  She is a Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham and Professor, Department of Medicine, Duke University Medical Center, Senior Fellow with the Duke University Center for Aging, and a former VA Career Development Awardee. 

Karen Steinhauser, PhD, is Professor, Departments of Population Health Sciences and Medicine, Duke University Medical Center and Senior Fellow with the Duke University Center for Aging and Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham. Her research is dedicated to improving patient and family psychosocial and spiritual care, in serious illness. She has developed measurement tools to assess patient and family quality of life as well as psychosocial interventions to improve the experience of serious illness for patients and those who care for them. Dr. Steinhauser's research has used qualitative and qualitative methods, observational, trial and implementation research.  Her latest work includes: developing a measure to assess the spiritual needs in palliative care, and addressing clinician resilience in palliative care. She serves as Associate Chief of Research for Duke Palliative Care, Director of the Duke Residency Professional Development Coaching program and Vice Chair of Faculty Development for Population Health Sciences. She has been a long-term member of AAHPM, having served on the research committee and being the 2015 Awardee for Excellence in Scientific Research in Palliative Care. She is the Director of Duke’s Residency Professional Development Coaching Program and Vice Chair for Faculty Development, Department of Population Health Sciences



Area of expertise: Palliative Care, Qualitative Research
Zullig

Leah L Zullig

Professor in Population Health Sciences

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research


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