title: Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation.
abstract: OBJECTIVE
  To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived.
  
  
  METHODS
  An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home.
  
  
  METHODS
  Convergent case study mixed methods design.
  
  
  METHODS
  Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database.
  
  
  RESULTS
  Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change.
  
  
  CONCLUSIONS
  Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence.
authors.affiliation: David Eccles School of Business, University of Utah, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Scammon
authors.forename: Andrada
authors.initials: A
authors.lastname: Tomoaia-Cotisel
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Day
authors.forename: Julie
authors.initials: J
authors.lastname: Day
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Waitzman
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Farrell
authors.forename: Michael K
authors.initials: MK
authors.lastname: Magill
mesh_terms: D003151:Community Health Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006282:Health Personnel / Q000458:organization & administration; D006302:Health Services Research / Q000191:economics / Q000379:methods* / Q000458:organization & administration*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007407:Interviews as Topic; D007857:Leadership; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D012107:Research Design
keywords: Practice transformation; mixed methods; patient centered medical home; primary care