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Effects of Underinsurance on Household Expenditures

PI: David Grande

In this project, open-ended, semi-structured interviews were used to explore the effects of underinsurance on families.  Thirty-five insured patients with chronic illnesses were interviewed to examine how they and their families cope with the stresses of their illnesses from a medical, financial, and social perspective.  The primary aim of the project was to investigate the tradeoffs families make when faced with significant illness and associated costs.   The MMRL played a primary role in data analysis including development of a coding scheme, line-by-line coding of transcripts in qualitative data analysis software, assistance with interpretation of coding results, and support with manuscript preparation.

Implementation Quality Study

PI: Steve Leff

In this project, investigators developed an innovative, mixed-methods approach to assess implementation quality (IQ) in group interventions for violence in schools using a participatory action research (PAR) model.  Under the PAR model, researchers within the Community Schools Program at The Children’s Hospital of Philadelphia and the MMRL collaborated with community stakeholders to jointly operationalize and analyze the implementation quality of an intervention conducted within identified community partners’ settings.  The mixed-methods approach used in this study includes: direct participant observations of intervention sessions; semi-structured interviews with stakeholders; a systematic literature review through which over 450 instruments that assess the IQ dimensions were identified; a grounded theory and meta-matrix approach which identified 5-10 distinct sub-dimensions for each of the IQ constructs; the classification of existing instruments into the sub-dimension categories and the use of qualitative data to generate new items. 

Caregiver and Left Ventricular Assist Devices as Destination Therapy (LVAD-DT) for End Stage Heart Failure:  A Pilot Study of a Journey

PI: James Kirkpatrick

LVADs are surgically-implantable devices which support the failing heart.  The many patients with end stage heart failure who are not transplant candidates may benefit from this intervention.  While these devices prolong life and improve quality of life, they are invasive, difficult to manage and may lead to devastating complications (such as stroke).  The overall purpose of this research study is to understand and describe the context in which decisions about LVAD-DT take place, as well as the impact the decisions have on the patients and their caregivers. In this project, multiple sources of data are used to analyze procedures, policies and informed consent documents from 5-7 LVAD-DT programs.  In addition, the project involves interviews with providers, patients and caregivers from each program with a set of open-ended questions. The caregivers will also be asked to fill out a validated survey instrument to assess their quality of life. These responses will be linked to the qualitative interviews to look for and explain differences.   The MMRL has been involved with the project since its inception, assisting initially with writing a successful grant proposal.  MMRL faculty and staff are currently involved in recruitment of participants, interviewing, data management, data coding, and data analysis for this project. 

Professionalism at the Perelman School of Medicine

PI: Alan Wasserstein

As part of a school-wide initiative to foster professionalism at the University of Pennsylvania’s Perelman School of Medicine, this project uses small-group Narrative Professionalism (NP) sessions in multiple residency and fellowship programs across the UPenn Health System to explore the clinical experiences of faculty, residents, and fellows.  Participants were invited to write informally--in response to a professionalism-themed topic--an account of an actual clinical experience with patients, family members, or colleagues that significantly shaped or tested their professionalism. For this project, the MMRL has been instrumental in managing a qualitative database of over 600 narrative stories, refining the coding scheme for analysis, incorporating categorical data about participants, analyzing and interpreting data and assisting in manuscript preparation. 

Housing as a Human Right

PI:  Carolyn Cannuscio

This minority youth development program is a project seeking to understand the meaning of home to the urban students and young adult participants in the Mural Corps art education and leadership development program.  Using qualitative and visual methods, the study includes interviews with high-risk, urban youth about elements of their lives that contribute to or detract from health and well-being. MMRL faculty and staff trained 10 artists and 33 students in qualitative interviewing techniques and facilitated recruitment and interviewing of participants.  Following the interviews, the MMRL has also managed all textual data and generated a white paper, highlighting some of the participants’ photographs from the project and elucidating the issues of housing insecurity and homelessness among Philadelphia’s youth.  MMRL staff also ensured the radio-quality of the interview recording to share with NPR/WHYY for a series of pieces about youth and housing insecurity

Patient-Centered Medical Home Project

PI: Rachel Werner

In collaboration with Dr. Robert Gabbay of Penn State – Hershey and Dr. Rachel Werner of UPenn, the MMRL is examining the transformation process that 25 primary care practices across Southeastern Pennsylvania have experienced over the past three years as they transitioned to the Patient-Centered Medical Home model of care. Qualitative interviews with multiple stakeholders are being conducted at each site resulting in over one hundred transcripts. Survey data, monthly narrative reports, and demographic information, specific to both the site and the individual participants will be used to strengthen the analysis. The goal of this research is to gain a deeper understanding of the effects this model has on providers/staff cohesion, practice costs, delivering quality patient care, and managing chronic conditions. The MMRL has assisted in conducting the qualitative interviews, data management and coding this immense and valuable data set.

Reducing Race/Ethnic Disparities in the Delivery of Maternal Depression Care for Low Income Women through a Continuous Quality Improvement Collaborative Care Intervention

PI: Ian Bennett

This ongoing project is a mixed methods evaluation of an intervention for maternal depression in four primary care sites in Pennsylvania which provide prenatal, postpartum, and general medical care for low income minority women. By combining qualitative methods with quantitative measures of care delivery, this study assesses the effectiveness of the ongoing Continuous Quality Improvement (CQI) interventions to increase the identification of major depressive disorder among pregnant and post-partum women and reduce the barriers to receiving treatment created by the multiple transitions of care. The MMRL was instrumental in preparing the proposal for this study and for assisting the PI in obtaining funding from the Robert Wood Johnson Foundation. Project staff are involved in planning and implementing the research design, conducting qualitative interviews and participant observations, and managing and coding data.

A Pilot Randomized Controlled Trial of Vacant Lot Greening and Violence-related Outcomes

PI: Eugenia Garvin

The broad objective of this pilot trial is to examine the impact of modifications of the built environment on the experience of crime and safety for people living in urban neighborhoods. Using a randomized controlled trial of vacant lot greening, this project seeks to investigate the feasibility of such an intervention, and begin to explore its impact on violence-related outcomes. Using a two phase approach, a total of 50 interviews were conducted with 29 community members in 2 locations with study vacant lots. Participants were interviewed in their home about the impact of vacant land on the health and safety of the residents and community. Participants also walked around the neighborhood with interviewers during which time their heart rate was recorded.  MMRL staff assisted with training the interviewers in qualitative interviewing techniques and advised the investigator regarding technical aspects of interviewing in the field. The MMRL has also been responsible for managing interview data, coding transcripts, assisting in interpretation of data and manuscript preparation.


Patient Perceptions of Transition from Hospital to Ambulatory Care

PI: Shreya Kangovi

This project is a cross-sectional mixed-methods study on patient perceptions of the transition from the hospital to ambulatory care, as experienced by patients discharged from Penn Medicine hospitals.  This two phase project includes an initial survey of patients rehospitalized within 30 days of discharge and interviews with groups of patients after their most recent hospitalization.  The goal of the project is to examine factors that might be associated with a successful transition from hospital to ambulatory care and design an intervention to facilitate this process.   The MMRL has provided support with project conceptualization, method assessment and alignment with aims, interview guide development and iterative refinement, coding scheme development, coding and data management, and mentorship on analysis. 

Understanding Barriers to Evaluation for Early Intervention Services: A Qualitative Study

PI: Manuel Jimenez

This project seeks to provide an in depth understanding of the barriers to evaluation for and enrollment in early intervention (EI) services and to identify possible strategies to overcome these barriers.  This qualitative study consists of semi-structured interviews with parents of urban children who were referred to EI and successfully evaluated, as well as those who never received an evaluation, and providers of the EI program to better understand perceptions of this process. Demographic information and a Health Literacy survey were also collected from parents for mixed methods analysis. For this project, the MMRL has been involved in recruitment, interviewing, data management, and data coding.  The MMRL is also providing mentorship with the analytic process.

Quantifying the alcohol-related risks of adolescent injury through field pictometry

PI: Charles Branas

In this study, pictometry – analyzing and quantifying photographs of the microspatial environment –is used to investigate the potential influence that microspatial factors may have on the risk of fatal adolescent injury. Research that addresses such microspatial factors will help community leaders design effective injury prevention interventions by identifying truly modifiable environmental factors in their neighborhoods. The overall goal of this project is to use pictometric and case-control study methods to quantify and analyze visible environmental factors, most notably alcohol-related factors that may generate fatal injury risks for adolescents.  The MMRL has collaborated on this project by providing methods consultations, training study field staff in participant observation techniques, and managing quantitative, qualitative and visual data. In addition, the MMRL has been instrumental in developing innovative methods for analyzing the photographic data.

Qualitative evaluation of the mechanisms by which rapid response systems impact patient safety

Co-PI’s: Christopher Bonafide MD, MSCE and Kathryn Roberts, RN, MSN, CNS, CCRN, CCNS

The Children’s Hospital of Philadelphia (CHOP) recently transitioned from using only a traditional “code blue” team to a rapid response system that includes an early warning score and a medical emergency team in addition to the “code blue” team. With the use of qualitative methods, this project aims to (1) identify the mechanisms by which rapid response systems improve patient safety, (2) identify barriers to safety that exist despite rapid response system implementation, and (3) identify the role of families in contributing to the decision making when critical illness evolves outside the ICU setting. To help achieve these project aims, a member of the Mixed Methods Research Lab (MMRL) staff, trained in qualitative methods, has assisted in project coordination, recruitment, data collection, data management, coding, data analysis, and manuscript preparation.