Expanding Our Methodological Toolbox to Improve Quality: The Role of Mixed-Methods Evaluations.
P Paul ChandanabhummaShiwei ZhouMichael Derwin FettersDonald S LikoskyPublished in: Circulation. Cardiovascular quality and outcomes (2023)
The care delivered to patients with cardiovascular disease involves coordination among a multitude of clinical team members spanning diverse inpatient and outpatient settings. The majority of quality improvement interventions in cardiovascular care have been developed based on quantitative evidence, which neither fully accounts for multilevel determinants (eg, patient, clinician, and institution) nor contextualization from key informants. The rigor and effectiveness of these interventions would be enhanced by mixed-methods studies whose strengths include (1) the use of qualitative research methodologies (eg, eliciting patient or clinician perspectives on barriers and facilitators of best practices) and (2) integrating qualitative and quantitative data and analyses to understand more fully effective strategies for achieving optimal care and outcomes for these patients across diverse settings. This article illustrates the application of a complex mixed-methods design to advance an evidence-based, customizable infection prevention toolkit for durable left ventricular assist device therapy. The study (1) uses quantitative clinical data merged with Medicare claims to evaluate interhospital variability in the incidence of infection; (2) uses qualitative methods to understand local practice patterns across low- and high-performing centers; and (3) integrates both data sources to gain a comprehensive understanding of the overall findings.
Keyphrases
- quality improvement
- palliative care
- healthcare
- cardiovascular disease
- systematic review
- patient safety
- electronic health record
- end stage renal disease
- physical activity
- left ventricular assist device
- randomized controlled trial
- high resolution
- study protocol
- big data
- case report
- chronic kidney disease
- newly diagnosed
- affordable care act
- peritoneal dialysis
- prognostic factors
- ejection fraction
- pain management
- stem cells
- machine learning
- clinical trial
- drinking water
- adipose tissue
- bone marrow
- metabolic syndrome
- deep learning
- smoking cessation
- data analysis
- case control
- insulin resistance