Abstract:
PURPOSE:We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors. METHODS:Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context. RESULTS:The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context. CONCLUSIONS:These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.
journal_name
Ann Fam Medjournal_title
Annals of family medicineauthors
Tomoaia-Cotisel A,Scammon DL,Waitzman NJ,Cronholm PF,Halladay JR,Driscoll DL,Solberg LI,Hsu C,Tai-Seale M,Hiratsuka V,Shih SC,Fetters MD,Wise CG,Alexander JA,Hauser D,McMullen CK,Scholle SH,Tirodkar MA,Schmidt L,Dondoi
10.1370/afm.1549subject
Has Abstractpub_date
2013-05-01 00:00:00pages
S115-23eissn
1544-1709issn
1544-1717pii
11/Suppl_1/S115journal_volume
11 Suppl 1pub_type
杂志文章abstract:PURPOSE:This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving low-inco...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.2418
更新日期:2019-07-01 00:00:00
abstract::Hatpins is a first-person narrative that delves into a physician's experience of a patient death during the early years of residency. The essay reflects on the conflicted physician-patient relationships that can develop even over the short tenure of residency. While residency seeks to create medically prepared and com...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2135
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Chronic hepatitis C, a treatable condition caused by the hepatitis C virus (HCV), can be found in almost all primary care and community practices. The rate of hepatitis C treatment is low, however. This study explores the frequency of hepatitis C treatment, documented discussions of treatment consideration, ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.62
更新日期:2004-03-01 00:00:00
abstract:PURPOSE:We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODS:We created recorded ...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1996
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:We undertook a study to understand how women who are victims of intimate partner violence (IPV) want physicians to manage these abusive relationships in the primary care office. METHODS:Thirty-two mothers in IPV shelters or support groups in southwestern Ohio were interviewed to explore their abuse experien...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.74
更新日期:2004-05-01 00:00:00
abstract:PURPOSE:The US Preventive Services Task Force (USPSTF) is authorized by the US government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before imp...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1194
更新日期:2011-01-01 00:00:00
abstract:PURPOSE:Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression i...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1418
更新日期:2012-07-01 00:00:00
abstract:PURPOSE:Students' idealism and desire to work with underserved populations decline as they progress from preclinical training through clerkships and residency. With an increasingly diverse population and increasing health disparities, academic health centers need to incorporate changes in their curricula to train socia...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.543
更新日期:2006-09-01 00:00:00
abstract:PURPOSE:Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODS:We undertook a descriptive analysi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1626
更新日期:2014-03-01 00:00:00
abstract:PURPOSE:There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectivene...
journal_title:Annals of family medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1370/afm.939
更新日期:2009-01-01 00:00:00
abstract:PURPOSE:In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (pers...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1692
更新日期:2014-11-01 00:00:00
abstract::Physician narratives in family medicine have the potential to convey the vibrant spirit of our field and provide meaningful insights into disease, illness, suffering, and the nature of healing. They may also complement empirical research, education, and practice through their integrative, expressive nature. This true ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.372
更新日期:2006-01-01 00:00:00
abstract:PURPOSE:We hypothesized that antibiotic overuse for acute cough illness (ACI) is in part due to a mismatch between patients' expectations and the natural history of ACI. METHODS:We performed a population-based random digit dialing survey of 493 adults in Georgia to determine their expectations regarding the duration o...
journal_title:Annals of family medicine
pub_type: 杂志文章,评审
doi:10.1370/afm.1430
更新日期:2013-01-01 00:00:00
abstract:PURPOSE:We undertook a study to examine the impact of experiences shared between patient and physician and the value patients place on continuity of care. METHODS:Data on 4,454 patients collected in The Direct Observation of Primary Care (DOPC) study conducted between October 1994 and August 1995 were analyzed to asse...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.84
更新日期:2004-09-01 00:00:00
abstract:PURPOSE:In primary care, the involvement of health care assistants (HCAs) in clinical depression management is an innovative approach. Little is known, however, about how HCAs experience their new tasks. We wanted to describe the perceptions and experiences of HCAs who provided case management to patients with depressi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1037
更新日期:2009-11-01 00:00:00
abstract:PURPOSE:Because recognition and management of patients with somatoform disorders are difficult, we wanted to determine the specificity, sensitivity, and the test-retest reliability of the 15-symptom Patient Health Questionnaire (PHQ-15) for detection of somatoform disorders in a high-risk primary care population. METH...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.985
更新日期:2009-05-01 00:00:00
abstract:PURPOSE:Conducting studies in national practice-based research networks presents logistic and methodologic challenges. Pediatric Research in Office Settings (PROS) has learned valuable lessons in implementing new strategies and adapting to challenges. We describe practical challenges and results of novel applied strate...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.1809
更新日期:2015-09-01 00:00:00
abstract::We sought to describe the proportion of patients in contact with a primary care physician, as well as the total number of primary care contacts over a 2-year period, using the 2002-2017 Medical Expenditure Panel Survey. The rate of any contact with a primary care physician for patients in the population decreased by 2...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2631
更新日期:2021-01-01 00:00:00
abstract:PURPOSE:Our goal was to describe an approach to patient-centered medical home (PCMH) measurement based on delineating the desired properties of the measurement relative to assumptions about the PCMH and the uses of the measure by Blue Cross Blue Shield of Michigan (BCBSM) and health services researchers. METHODS:We de...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1472
更新日期:2013-05-01 00:00:00
abstract:PURPOSE:Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.2171
更新日期:2018-01-01 00:00:00
abstract:PURPOSE:We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities. METHODS:The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identif...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.553
更新日期:2006-09-01 00:00:00
abstract:PURPOSE:Automated office blood pressure monitoring during 30 minutes (OBP30) may reduce overtreatment of patients with white-coat hypertension in primary health care. OBP30 results approximate those of ambulatory blood pressure monitoring, but OBP30 is much more convenient. In this study, we compared OBP30 with routine...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2041
更新日期:2017-03-01 00:00:00
abstract:PURPOSE:The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators. METHODS:We conducted a cross-sectional, population-based study of fee-for-service and capitated interprofessional and non-interprofe...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1864
更新日期:2016-01-01 00:00:00
abstract:PURPOSE:To assess the effect of a primary care-based community-links practitioner (CLP) intervention on patients' quality of life and well-being. METHODS:Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to ...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.2429
更新日期:2019-11-01 00:00:00
abstract:PURPOSE:Peer health coaches offer a potential model for extending the capacity of primary care practices to provide self-management support for patients with diabetes. We conducted a randomized controlled trial to test whether clinic-based peer health coaching, compared with usual care, improves glycemic control for lo...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1443
更新日期:2013-03-01 00:00:00
abstract::POEMs (patient-oriented evidence that matters) are studies that address a relevant clinical question, demonstrate improved patient-oriented outcomes, and have the potential to change practice. For 20 years the authors of this article have reviewed more than 100 English language clinical journals monthly to identify PO...
journal_title:Annals of family medicine
pub_type: 历史文章,杂志文章,评审
doi:10.1370/afm.2288
更新日期:2018-09-01 00:00:00
abstract:PURPOSE:Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection;...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.1954
更新日期:2016-07-01 00:00:00
abstract:PURPOSE:The risk of an injury increases exponentially with alcohol consumption on a given occasion, but the conclusion that alcohol-related injuries are attributable primarily to heavy drinking may or may not be correct. The prevention paradox states that a large number of people at small risk may contribute more cases...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.243
更新日期:2005-01-01 00:00:00
abstract::I had intended to spend our spring break week in Montana with my kids and my dad, going to parks and museums together. Instead, I spent the week in the hospital, helping my dad make end-of-life choices and learning more about the importance of communication in health care settings and the preciousness of close relatio...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1908
更新日期:2016-05-01 00:00:00
abstract::Patient-choice cesarean delivery is increasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.537
更新日期:2006-05-01 00:00:00