title: Evaluation of the group health cooperative access initiative: study design challenges in estimating the impact of a large-scale organizational transformation.
abstract: The Institute of Medicine argues that poorly designed delivery systems are a major cause of low-quality care in the United States but does not present methods for evaluating whether its recommendations, when implemented by a health care organization, actually improve quality of care. We describe how time-series study designs using individual-level longitudinal data can be applied to address methodological challenges in our evaluation of the impact of the Group Health Cooperative "Access Initiative," an integrated set of 7 "patient-centered" reforms in its integrated delivery system that are consistent with the Institute of Medicine's recommendations. The methods may be generalizable to evaluating similar reforms in other integrated delivery systems with representative patient and physician data sources.
authors.affiliation: Group Health Cooperative, Center for Health Studies, Washington, Seattle, USA.
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Conrad
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
authors.forename: Diane P
authors.initials: DP
authors.lastname: Martin
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: David
authors.initials: D
authors.lastname: Carrell
authors.forename: Julia
authors.initials: J
authors.lastname: Hecht
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000592:standards*; D005069:Evaluation Studies as Topic; D018166:Health Care Reform; D006297:Health Services Accessibility; D017146:Models, Organizational; D018802:Patient-Centered Care; D011785:Quality Assurance, Health Care; D013997:Time Factors; D014861:Washington