Primary Care Research 2010

8/21/2019 Primary Care Research 2010

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Primary Care Research: AnPrimary Care Research: AnIntroduction (To Some ReallyIntroduction (To Some Really

Important Concepts)Important Concepts)John B. Schorling !.". !.P.#.John B. Schorling !.". !.P.#.

Pro$essor o$ !edicine and Pu%lic #eath SciencesPro$essor o$ !edicine and Pu%lic #eath Sciences

James R. !artindale Ph.".James R. !artindale Ph.".

Assistant Pro$essor o$ Research and Pu%lic Assistant Pro$essor o$ Research and Pu%lic#ealth Sciences#ealth Sciences


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&%'ecties:&%'ecties:

Be a%le to %etter $ormulate a researchBe a%le to %etter $ormulate a researchuestionuestion

*eel more com$orta%le +ith the clinical*eel more com$orta%le +ith the clinicalresearch processresearch process

,nderstand the ideas o$ constructs and,nderstand the ideas o$ constructs andoperationali-ationoperationali-ation

,nderstand the ma'or di$$erences %et+een,nderstand the ma'or di$$erences %et+eenuantitatie and ualitatie approaches touantitatie and ualitatie approaches todoing educational researchdoing educational research


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I$ +e /ne+ +hat +e +ereI$ +e /ne+ +hat +e +eredoing it +ouldn0t %e calleddoing it +ouldn0t %e called

research +ould it12research +ould it12

Al%ert 3instein Al%ert 3instein


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"eeloping 4our 5uestion"eeloping 4our 5uestion

Start +ith a clear purposeStart +ith a clear purpose

6no+ your literature6no+ your literature

Be iteratie in your approachBe iteratie in your approach Try to speci$y the +ho +hat +here and +henTry to speci$y the +ho +hat +here and +hen

o$ your purposeo$ your purpose

As/ yoursel$ 7hat +ould the ans+er to this As/ yoursel$ 7hat +ould the ans+er to thisuestion add to the literature12 and8uestion add to the literature12 and8


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"eeloping 4our 5uestion"eeloping 4our 5uestion

"on0t let methodology drie the uestion9"on0t let methodology drie the uestion9


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The Research ProcessThe Research Process

.. Identi$ication o$ general pro%lem;uestionIdenti$ication o$ general pro%lem;uestion

. Speci$y uestions;hypothesesSpeci$y uestions;hypotheses

?.?. "etermination o$ design;methodology"etermination o$ design;methodology

@.@. "ata collection"ata collection

.. "ata analysis;presentation"ata analysis;presentation.. Interpretation o$ $indingsInterpretation o$ $indings


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The Right and the =e$tThe Right and the =e$t

5uantitatie research num%ers5uantitatie research num%ers

num%ers num%ersnum%ers num%ers

5ualitatie research +ords +ords5ualitatie research +ords +ords

+ords+ords


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5uantitatie s. 5ualitatie:5uantitatie s. 5ualitatie:

Assumptions a%out the 7orld Assumptions a%out the 7orld Based upon the ideaBased upon the idea

o$ logicalo$ logical

positiism2 that ispositiism2 that isthere is a singularthere is a singular

reality +ith sta%lereality +ith sta%le

social $acts that aresocial $acts that are

separate $rom theseparate $rom the$eelings and %elie$s$eelings and %elie$s

o$ indiiduals.o$ indiiduals.

Based on the notionBased on the notiono$ constructiism2o$ constructiism2+hich assumes+hich assumesmultiple realities thatmultiple realities thatare sociallyare sociallyconstructed throughconstructed throughindiidual andindiidual and

collectie perceptionscollectie perceptionsor ie+s o$ the sameor ie+s o$ the samesituation.situation.


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Research PurposeResearch Purpose See/s to esta%lishSee/s to esta%lish

relationships andrelationships and

eDplain causes o$eDplain causes o$changes inchanges in

measured aria%les.measured aria%les.

That is the goal o$That is the goal o$

science is to eDplainscience is to eDplainand predict.and predict.

Concern is +ith theConcern is +ith the

understanding o$ theunderstanding o$ the

social phenomenonsocial phenomenon$rom the$rom the

participants0participants0

perspecties. Thisperspecties. This

reuires to somereuires to somedegree researcherdegree researcher

participation.participation.


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!ethods and Process!ethods and Process The scienti$icThe scienti$ic

method also /no+nmethod also /no+n

as a priori or preas a priori or preesta%lished design.esta%lished design.

,se o$ emergent,se o$ emergent

design utili-ingdesign utili-ing

constantconstantcomparison andcomparison and

reision.reision.


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Prototypical StudiesPrototypical Studies 3Dperimental or3Dperimental or

correlational designscorrelational designs

are used to reduceare used to reduceerror %ias and theerror %ias and the

in$luence o$in$luence o$

eDtraneouseDtraneous

aria%lescontrol o$aria%lescontrol o$%ias is through%ias is through

design.design.

,se o$ ethnography,se o$ ethnography+hich helps readers+hich helps readersunderstand theunderstand themultiple perspectiesmultiple perspectieso$ the situation %y theo$ the situation %y thepersons studied.persons studied.Su%'ectiity in dataSu%'ectiity in data

analysis andanalysis andinterpretation isinterpretation isac/no+ledged.ac/no+ledged.


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Researcher RoleResearcher Role "etachment $rom"etachment $rom

study in order tostudy in order to

aoid %ias.aoid %ias.

Immersion inImmersion in

situation and thesituation and the

phenomenon %eingphenomenon %eingstudied.studied.


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ConteDtConteDt ConteDt$reeConteDt$ree

generali-ationsgenerali-ations

Eenerali-ations areEenerali-ations are

conteDtually%ound.conteDtually%ound.


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PrecisionPrecision &%tained through&%tained through

the use o$the use o$

measurement andmeasurement andstatisticsstatistics

Proided %y detailedProided %y detailed

description o$description o$

phenomenonphenomenon


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Feri$icationFeri$ication Results replicatedResults replicated

%y others.%y others.

3Dtension o$3Dtension o$

understandings %yunderstandings %y

others.others.


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3Dplanation3Dplanation TraditionallyTraditionally

parsimoniousparsimonious

eDplanations +ereeDplanations +eresought %ut this maysought %ut this may

%e changing due to%e changing due to

technology.technology.

Summary throughSummary through

narratienarratie

importance is placedimportance is placedon reducingon reducing

compleD realities tocompleD realities to

simple eDplanations.simple eDplanations.


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=ogical Reasoning=ogical Reasoning "3",CTIF3"3",CTIF3

7hat0s the classic7hat0s the classic

eDample1eDample1

IG",CTIF3IG",CTIF3

anyone hae ananyone hae an

eDample1eDample1


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Conditional ConclusionsConditional Conclusions Statements o$Statements o$

statistical pro%a%ility.statistical pro%a%ility.

Tentatie summaryTentatie summary

interpretations.interpretations.


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Types o$ 5uantitatie StudiesTypes o$ 5uantitatie Studies

"escriptie"escriptie

True eDperimentalTrue eDperimental

5uasieDperimental5uasieDperimental

CorrelationalCorrelational

PredictiePredictie


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Research ,sing Primary "ataResearch ,sing Primary "ata

CrosssectionalCrosssectional

Case ControlCase Control

CohortCohort

Randomi-ed controlled trialRandomi-ed controlled trial


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Crosssectional StudyCrosssectional Study

"ata gathered at one point in time"ata gathered at one point in time

&$ten used $or sureys&$ten used $or sureys

Can not ma/e in$erences a%outCan not ma/e in$erences a%outcausalitycausality


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Ro%ert Johnston0s Pro'ect

Interested in PTS" Reie+ed literature on PTS" in primary care

settings $or his P&! presentation "ecided to do a surey to determine prealence

and associated conditions Reie+ed eDisting instruments

Surey includes < PTS" uestionnaires A,"ITS*< and P#5H

&%tained IRB approal June


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Case Control StudyCase Control Study

Start +ith the outcome identi$y aStart +ith the outcome identi$y a

sample +ith the condition o$ interestsample +ith the condition o$ interest

Identi$y a similar control groupIdenti$y a similar control group

=oo/ %ac/ to determine eDposure=oo/ %ac/ to determine eDposure

Calculate the ris/ in the cases andCalculate the ris/ in the cases and

controls odds ratio usedcontrols odds ratio used

Can not use to esta%lish prealenceCan not use to esta%lish prealence


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Cohort StudyCohort Study

Start +ith an identi$ied groupStart +ith an identi$ied group "etermine eDposure in eeryone at the"etermine eDposure in eeryone at the

same timesame time *ollo+ the group to determine +ho*ollo+ the group to determine +ho

deelops the outcome o$ interestdeelops the outcome o$ interest

Can %e used to determine prealenceCan %e used to determine prealence Association measured as relatie ris/ Association measured as relatie ris/

(rate ratios)(rate ratios)


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Randomi-ed Controlled TrialRandomi-ed Controlled Trial

Eold standard $or determiningEold standard $or determining

associationsassociations

Identi$y a groupIdenti$y a group

Randomly assign indiiduals toRandomly assign indiiduals to

eDposureeDposure

&nly relia%le +ay to control $or&nly relia%le +ay to control $or

con$oundingcon$ounding


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Research ,sing Secondary "ataResearch ,sing Secondary "ata

=iterature reie+=iterature reie+

Systematic reie+Systematic reie+

!etanalysis!etanalysis

Analysis o$ eDisting data collected $or Analysis o$ eDisting data collected $or

another purposeanother purpose


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=iterature Reie+=iterature Reie+

Eather articles on a topic o$ interestEather articles on a topic o$ interest

Summari-e the $indingsSummari-e the $indings


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Systematic Reie+Systematic Reie+

Eather articles using a prede$inedEather articles using a prede$ined

search strategy may includesearch strategy may include

unpu%lished studiesunpu%lished studies "eelop apriori o%'ectie criteria to"eelop apriori o%'ectie criteria to

ealuate the uality o$ the studiesealuate the uality o$ the studies

Summari-e the uality o$ the data andSummari-e the uality o$ the data andthe resultsthe results


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!etanalysis!etanalysis

"o a systematic reie+"o a systematic reie+

&%tain the primary data i$ possi%le&%tain the primary data i$ possi%le

Summari-e the data uantitatielySummari-e the data uantitatiely


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Analysis o$ 3Disting "ata Analysis o$ 3Disting "ata

,se administratie data $or research,se administratie data $or research Insurance claims data !edicareInsurance claims data !edicare

Central "ata Repository (C"R) at ,FaCentral "ata Repository (C"R) at ,Fa ,se regularly collected surey data,se regularly collected surey data

Gational Center $or #ealth StatisticsGational Center $or #ealth Statistics

per$orms multiple sureys periodicallyper$orms multiple sureys periodicallyGA!CS G#IS G!C3S G#AG3SGA!CS G#IS G!C3S G#AG3S

,se data collected $or another study,se data collected $or another study


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Timeline $or ESP Research Pro'ectTimeline $or ESP Research Pro'ect

*all


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T#AG6 4&,9T#AG6 4&,9

Contact: 'rmeKirginia.eduContact: 'rmeKirginia.edu

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Primary Care Research 2010