scholarly journals Characterizing performance improvement in primary care systems in Mesoamerica: A realist evaluation protocol

2018 ◽  
Vol 2 ◽  
pp. 1 ◽  
Author(s):  
Wolfgang Munar ◽  
Syed S. Wahid ◽  
Leslie Curry
Keyword(s):  
Primary Care ◽  
Performance Measurement ◽  
Study Design ◽  
Care Delivery ◽  
Realist Evaluation ◽  
Case Study Design ◽  
Evaluation Protocol ◽  
Primary Care Delivery ◽  
Salud Mesoamérica Initiative

Background. Evaluations of performance measurement and management interventions in public, primary care delivery systems of low- and middle-income countries are scarce. In such contexts, few studies to date have focused on characterizing how, why and under what contextual conditions do such complex, multifaceted arrangements lead to intended and unintended consequences for the healthcare workforce, the healthcare organizations involved, and the communities that are served. Methods. Case-study design with purposeful outlier sampling of high-performing primary care delivery systems in El Salvador and Honduras, as part of the Salud Mesoamerica Initiative. Case study design is suitable for characterizing individual, interpersonal and collective mechanisms of change in complex adaptive systems. The protocol design includes literature review, document review, non-participant observation, and qualitative analysis of in-depth interviews. Data analysis will use inductive and deductive approaches to identify causal patterns organized as ‘context-mechanism-outcome’ configurations. Findings will be triangulated with existing secondary data sources collected including country-specific performance measurement data, impact, and process evaluations conducted by the Salud Mesoamerica Initiative. Discussion. This realist evaluation protocol aims to characterize how, why and under what conditions do performance measurement and management arrangements contribute to the improvement of primary care system performance in two low-income countries.

scholarly journals Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol

2018 ◽  
Vol 2 ◽  
pp. 27 ◽  
Author(s):  
Wolfgang Munar ◽  
Birte Snilstveit ◽  
Jennifer Stevenson ◽  
Nilakshi Biswas ◽  
John Eyers ◽  
...  
Keyword(s):  
Primary Care ◽  
Global Health ◽  
Performance Measurement ◽  
Study Design ◽  
Care Delivery ◽  
Delivery Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Delivery ◽  
Low And Middle Income

Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Implications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.

scholarly journals Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol

2018 ◽  
Vol 2 ◽  
pp. 27 ◽  
Author(s):  
Wolfgang Munar ◽  
Birte Snilstveit ◽  
Jennifer Stevenson ◽  
Nilakshi Biswas ◽  
John Eyers ◽  
...  
Keyword(s):  
Primary Care ◽  
Global Health ◽  
Performance Measurement ◽  
Study Design ◽  
Care Delivery ◽  
Delivery Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Delivery ◽  
Low And Middle Income

Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Applications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.

scholarly journals Team- and individual-level motivation in complex primary care system change: A realist evaluation of the Salud Mesoamerica Initiative in El Salvador

2018 ◽  
Vol 2 ◽  
pp. 55 ◽  
Author(s):  
Wolfgang Munar ◽  
Syed S. Wahid ◽  
Sangeeta Mookherji ◽  
Cinzia Innocenti ◽  
Leslie Curry
Keyword(s):  
Primary Care ◽  
Performance Measurement ◽  
El Salvador ◽  
Collective Efficacy ◽  
Large Scale ◽  
Realist Evaluation ◽  
High Performing ◽  
Care Systems ◽  
Salud Mesoamérica Initiative

Background: We study the role of individual and team-level motivation in explaining large-scale primary care performance improvements in El Salvador, one of the top-performing countries in the Salud Mesoamerica Initiative. Methods: Case study with outlier sampling of high-performing, community health teams in El Salvador. Design includes scoping review of literature, document review, non-participant observation, and qualitative analysis of in-depth interviews following a realist case study protocol. Results: The interplay between program interventions and organizational, community and policy contexts trigger multi-level motivational mechanisms that operate in complex, dynamic fashion. Interventions like performance measurement and team-based, in-kind incentives foster motivation among individual members of high-performing teams, which may be moderated by working conditions, supervision practices, and by the stress exerted by the interventions themselves. Individuals report a strong sense of public service motivation and an overarching sense of commitment to the community they serve. At the interpersonal level, the linkage between performance measurement and in-kind incentives triggers a sense of collective efficacy and increases team motivation and improvement behaviors. The convening of learning forums and performance dialogue increases the stakes for high-performing teams, helps them make sense of performance data, and leads to performance information utilization for healthcare improvements. Closeness to communities creates strong emotional linkages among team members that further increases collective efficacy and social identity. Such changes in individuals, team, and organizational behaviors can contribute to improved delivery of primary care services and explain the gains in performance demonstrated by the program. Conclusions: This case suggests that primary care systems that rely on multi-disciplinary teams for the provision of care can benefit from performance measurement and management interventions that leverage individual and team-level motivation. Realist evaluation can help prioritize policy-relevant research and enhance the design and evaluation of large-scale performance reforms in primary care systems in low- and middle-income settings.

scholarly journals Horizontal integration and financial reform of a primary care delivery system in Pengshui County, China: a case study

The Lancet ◽  
2019 ◽  
Vol 394 ◽  
pp. S98
Author(s):  
Zhi Zeng ◽  
Wenjuan Tao ◽  
Chunping Liu ◽  
Lin Zhou ◽  
Jianbo Pan ◽  
...  
Keyword(s):  
Primary Care ◽  
Delivery System ◽  
Care Delivery ◽  
Financial Reform ◽  
Horizontal Integration ◽  
Primary Care Delivery

scholarly journals The integration of occupational therapy into primary care: a multiple case study design

2013 ◽  
Vol 14 (1) ◽  
Author(s):  
Catherine Donnelly ◽  
Christie Brenchley ◽  
Candace Crawford ◽  
Lori Letts
Keyword(s):  
Primary Care ◽  
Occupational Therapy ◽  
Study Design ◽  
Multiple Case Study ◽  
Case Study Design ◽  
Multiple Case

How do you diagnose asthma? A multiple case study design to understand and explain current use of national guidelines by primary care clinicians

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711485
Author(s):  
Fiona Hares ◽  
Daniel Menzies ◽  
Paul Brocklehurst ◽  
Sion Williams
Keyword(s):  
Primary Care ◽  
Study Design ◽  
Nursing Staff ◽  
Multiple Case Study ◽  
Scottish Intercollegiate Guideline Network ◽  
Asthma Care ◽  
Case Study Design ◽  
Multiple Case ◽  
Primary Care Clinicians

BackgroundClinical guidelines for asthma are available to UK clinicians but implementation is not straightforward. Diagnostic and treatment inadequacy contribute to patient morbidity and mortality and lack of adherence to guidelines is a component of this.AimThis qualitative study sought to explore and understand the use of asthma guidelines by primary care clinicians in two geographically bounded regions of Wales.MethodMultiple case study design was used. Data was collected using semi-structured interviews with a purposively sampled group of clinical staff from GP practices. Interview transcripts were thematically analysed to produce a detailed picture of practice.ResultsAsthma care in the studied areas operated as a social network of clinicians who often used guidelines as boundary objects. Practice and local service design was influenced and dependent on regular input from local secondary care providers. Clinicians looked to British Thoracic Society and Scottish Intercollegiate Guideline Network (BTS/SIGN) 2016 guidelines. There was limited use of National Institute for Health and Care Excellence (NICE) 2017 guidelines. Barriers to guideline recommended diagnostic asthma care included: lack of acceptability, financial costs and disempowerment of nursing staff.ConclusionThe findings from this study replicate and reinforce the findings of previous work. It is striking and concerning that the thematic outcomes of this study bear a strong resemblance to that which was demonstrated over a decade ago. The guideline-implementation gap in asthma diagnostics will likely persist unless there is significant restructuring, financial investment and greater empowerment of nursing staff in primary care.

Ties to the outside: An exploration of faculty interactions with external organizations

2018 ◽  
Vol 4 (1) ◽  
pp. 295-313 ◽  
Author(s):  
Karley A Riffe
Keyword(s):  
Study Design ◽  
Financial Constraints ◽  
Academic Discipline ◽  
Faculty Members ◽  
Faculty Work ◽  
Case Study Design ◽  
Low Resource ◽  
Faculty Interactions ◽  
Embedded Case Study

Faculty work now includes market-like behaviors that create research, teaching, and service opportunities. This study employs an embedded case study design to evaluate the extent to which faculty members interact with external organizations to mitigate financial constraints and how those relationships vary by academic discipline. The findings show a similar number of ties among faculty members in high- and low-resource disciplines, reciprocity between faculty members and external organizations, and an expanded conceptualization of faculty work.

Sign in / Sign up

Export Citation Format

Share Document