Mixed-Methods Research in a Complex Multisite VA Health Services Study: Variations in the Implementation and Characteristics of Chiropractic Services in VA.
Maximizing the quality and benefits of newly established chiropractic services represents an important policy and practice goal for the US Department of Veterans Affairs' healthcare system. Understanding the implementation process and characteristics of new chiropractic clinics and the determinants and consequences of these processes and characteristics is a critical first step in guiding quality improvement. This paper reports insights and lessons learned regarding the successful application of mixed methods research approaches-insights derived from a study of chiropractic clinic implementation and characteristics, Variations in the Implementation and Characteristics of Chiropractic Services in VA (VICCS). Challenges and solutions are presented in areas ranging from selection and recruitment of sites and participants to the collection and analysis of varied data sources. The VICCS study illustrates the importance of several factors in successful mixed-methods approaches, including (1) the importance of a formal, fully developed logic model to identify and link data sources, variables, and outcomes of interest to the study's analysis plan and its data collection instruments and codebook and (2) ensuring that data collection methods, including mixed-methods, match study aims. Overall, successful application of a mixed-methods approach requires careful planning, frequent trade-offs, and complex coding and analysis.
VA Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, Los Angeles, CA 91343, USA ; Military Medical Research Program, Samueli Institute, Corona del Mar, CA, USA.
Raheleh
R
Khorsan
VA Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, Los Angeles, CA 91343, USA.
Angela B
AB
Cohen
Chiropractic Program, Patient Care Services, Veterans Health Administration, Washington, DC, USA ; Chiropractic Service, VA Connecticut Healthcare System, West Haven, CT, USA.
Anthony J
AJ
Lisi
VA Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, Los Angeles, CA 91343, USA.
Monica M
MM
Smith
VA Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, Los Angeles, CA 91343, USA.
Deborah
D
Delevan
RAND Corporation, Boston, MA, USA.
Courtney
C
Armstrong
VA Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, Los Angeles, CA 91343, USA.
Brian S
BS
Mittman