Understanding practice from the ground up.

Area of Science:

• Primary Care Research
• Health Services Research
• Medical Practice Analysis

Background:

• Understanding family practices requires in-depth observation of the practice environment and patient care.
• Previous research focused on preventive service delivery, necessitating a ground-up examination of practice dynamics.

Purpose of the Study:

• To comprehensively understand family practices through direct observation.
• To gain insights into practice environments and patient care activities.
• To explore physician- and practice-level delivery of preventive services.

Main Methods:

• Utilized a comparative case study design with 18 purposefully selected family practices.
• Employed extended direct observation, interviews, and medical record review over 4-12 weeks per practice.
• Integrated complexity science concepts and a multimethod assessment process (MAP).

Main Results:

• The multimethod assessment process (MAP) yielded rich data on practice organization and patient care.
• Quantitative data documented the delivery of evidence-based preventive services at physician and practice levels.
• Insights from initial data collection guided subsequent analysis and research design.

Conclusions:

• The multimethod assessment process (MAP) effectively described primary care practice facets.
• The study facilitated testing hypotheses and discovering new insights grounded in participant experiences.
• This approach fostered a collaborative model for practice-based research and change.