Biomedical subjects

K J Devers

Publications and source records attributed to K J Devers.

10 recordsLinked to original sources

PubMed2001

Getting qualitative research published.

Translating research findings in health education into a publishable manuscript is challenging regardless of whether qualitative or quantitative methods are used. In this paper, we offer practical advice about how to successfully prepare and guide manuscripts based on qualitative research methods, in particular through the peer-reviewed journal publication process. Researchers trying to publish qualitative findings may face some unique challenges, given the field's current knowledge of qualitative methods, evaluation criteria, and conventional manuscript styles and length.

Journal Article↗

PubMed2001

Health plan-provider showdowns on the rise.

During the past two years, increasing numbers of contract disputes between health plans and hospitals and physicians have erupted in local markets, according to recent Center for Studying Health System Change (HSC) visits to 12 nationally representative communities. Many providers are taking a hard line in negotiations, threatening to terminate health plan contracts if payment demands go unmet. These contract showdowns signal a shift in the balance of power in local markets toward hospitals and physicians and can potentially disrupt care for many patients, especially when the disputes involve communities' largest and most prominent hospitals and physician groups. This Issue Brief presents case studies of showdowns in Boston, Orange County, Calif., and Seattle, highlighting the changing market dynamics triggering these disputes and the implications for consumers, including rising costs and diminished access to care.

Contract Services↗

PubMed2000

Study design in qualitative research--1: Developing questions and assessing resource needs.

This is the second in a series of four papers on understanding and doing qualitative research [Frankel & Devers (2000) Qualitative research: a consumer's guide, Education for Health, 13, 113-123; Devers & Frankel (2000) Study design in qualitative research--2: sampling and data collection strategies, Education for Health, 13, 263-271]. Here, we focus on problems of study design, including question development, literature review, identifying a target audience and resource needs assessment. We provide a step-by-step description of major issues and choice points in the process. There are three key differences between qualitative and quantitative research designs. First, the logic of qualitative research is often inductive, rather than deductive, and consists of describing people's and groups' particular situations, meanings and experiences. Second, qualitative research designs are often emergent and flexible, and the research itself is quite dynamic. Third, the qualitative research process is non-linear and non-sequential. There is agreement that good qualitative studies answer clearly stated, important research questions. How qualitative research questions are formulated has implications for conducting a literature review. Some scholars believe that literature should be reviewed prior to beginning a study; others argue that this may impede the researcher from truly listening, observing and remaining open to new concepts and ideas. We offer suggestions about formulating research questions and how and when to conduct a literature review. Another important issue in conducting qualitative research is determining the resources that will be needed to conduct a study. These include internal resources, such as research skills, and external resources, such as personnel (expertise and time), equipment, supplies and travel. A description of typical resource and management issues in conducting a qualitative research study is included.

Journal Article↗

PubMed2000

Study design in qualitative research--2: Sampling and data collection strategies.

In two prior papers in our series on qualitative research [Frankel & Devers (2000a, 2000b) Qualitative research: a consumer's guide, Education for Health, 13, 113-123; Frankel & Devers (2000) Study design in qualitative research-1: developing research questions and assessing research needs, Education for Health, 13, 251-261], we examine two critical issues in qualitative research design: sampling, including identifying and negotiating access to research sites and subjects, and data collection and management. We describe these two key steps in the qualitative research design process, discuss challenges that often emerge when pursuing these steps, and provide guidelines for addressing them. Qualitative research most often uses "purposive," rather than random, sampling strategies. A good understanding of these sampling strategies and why they are used is central to designing a credible qualitative study. In addition, given the real-world context in which most qualitative research is carried out, identifying and negotiating access to research sites and subjects are critical parts of the process. We also provide suggestions for developing and maintaining productive and mutually satisfying research relationships with sites and subjects. Finally, data collection and management are often neglected subjects in qualitative research. We offer practical advice on how to collect and manage qualitative data, including factors to consider when deciding how structured the data collection process should be, the pros and cons of audio- and/or videotaping compared with note-taking, and tips for writing up field notes and document management. A forthcoming, final paper in the series will focus on qualitative data analysis and the publication of qualitative research results.

Journal Article↗

PubMed1999

How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research.

OBJECTIVE: To lay the foundation for an explicit review and dialogue concerning the criteria that should be used to evaluate qualitative health services research. Clear criteria are critical for the discipline because they provide a benchmark against which research can be assessed. DATA SOURCES: Existing literature in the social sciences and health services research, particularly in primary care and medicine. PRINCIPAL FINDING: Traditional criteria for evaluating qualitative research are rooted in the philosophical perspective (positivism) most closely associated with quantitative research and methods. As a result, qualitative research and methods may not be used as frequently as they can be and research results generated from qualitative studies may not be disseminated as widely as possible. However, alternative criteria for evaluating qualitative research have been proposed that reflect a different philosophical perspective (post-positivism). Moreover, these criteria are tailored to the unique purposes for which qualitative research is used and the research designs traditionally employed. While criteria based on these two different philosophical perspectives have much in common, some important differences exist. CONCLUSION: The field of health services research must engage in a collective, "qualitative" process to determine which criteria to adopt (positivist or post-positivist), or whether some combination of the two is most appropriate. Greater clarity about the criteria used to evaluate qualitative research will strengthen the discipline by fostering a more appropriate and improved use of qualitative methods, a greater willingness to fund and publish "good" qualitative research, and the development of more informed consumers of qualitative research results.

Health Services Research↗

PubMed1995

Reinventing the American hospital.

The American hospital is being reinvented to conform with the forces that are replacing the acute, inpatient-oriented illness model of health care with a disease-prevention, health-promotion, primary-care one. Although hospitals will no longer conduct the "core business" of American health care, they can play a key role by empowering others and facilitating the integration of health services across the continuum of care. New management and governance structures will be required, as will population-based health status needs assessments, new relations with physicians, re-engineering of the clinical processes, organization-wide commitment to improving quality, information systems that link patients and providers, and creation of an overall community care management system. Despite major barriers, there are examples of progress.

Community Health Planning↗

PubMed1994

Implementing organized delivery systems: an integration scorecard.

Organized vertically integrated health systems are in a key position to play a major role in present health care reform efforts. To demonstrate a competitive advantage in the new health care environment, however, integration efforts must be successful. Based on a national study of nine organized delivery systems, this article develops measures of three types of integration that occur in vertically integrated health systems--functional, physician-system, and clinical. These measures can be used as a "scorecard" to assess progress toward achieving integration objectives.

Comprehensive Health Care↗

PubMed1992

Continuously improving patient care: practical lessons and an assessment tool from the National ICU Study.

Pressure for hospitals to maintain quality while lowering cost or provide greater quality at a given level of cost is particularly critical in intensive care services for which it is increasingly difficult to match revenues with costs, given reimbursement limits. At the same time, twofold to threefold differences in intensive care unit risk-adjusted mortality have been reported. This article provides a model for thinking about continuous improvement of intensive care services, draws on the National ICU Study to identify fundamental organizational and managerial processes associated with better performance, and offers a validated assessment instrument to be used as a tool for continuous improvement.

Communication↗

PubMed1991

Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire.

Health Services Research has a growing need for reliable and valid measures of managerial practices and organizational processes. A national study of 42 intensive care units involving over 1,700 respondents provides evidence for the reliability and validity of a comprehensive set of measures related to leadership, organizational culture, communication, coordination, problem solving-conflict management and team cohesiveness. The data also support the appropriateness of aggregating individual respondent data to the unit level. Implications for further research are discussed.

Analysis of Variance↗

PubMed1990

The changing role of the autopsy: a social environmental perspective.

Over the past decade, the declining autopsy rate has been the subject of much debate. Many articles in professional journals have explored both the cause of the decline as well as its desirability. Explanations for the declining rate of autopsies have typically been of two types, specifically "professional" and "technical." The former implicate declining professional standards, while the latter point to the emergence of new diagnostic technologies as the cause of the lower autopsy rate. This paper argues that both of these explanations are better understood as two components of a larger explanation known as the "social environmental perspective." Applied to the autopsy debate, the environmental perspective focuses on social, political, and economic forces that influence research hospitals and the different groups of people practicing within them. By placing the debate in a larger social framework, a more complete understanding of the declining autopsy rate may be reached. More important, it is hoped that the illumination of social processes affecting the work of medical professionals will encourage explicit discussions of those forces and possible ways of dealing with them.

Autopsy↗