A Qualitative Comparative Analysis of the Conditions Affecting Early Maternal Transfer Patterns
ABSTRACT In Arkansas, almost all of the high-risk-pregnancy resources are concentrated in a single place, at the University of Arkansas for Medical Sciences (UAMS). During the 6-month period before a telemedicine programme started, there were five operational telemedicine sites in the state, and during the subsequent 12-month period, there were 13 telemedicine sites in operation. Data were gathered on birth-related transfers during the two periods. Qualitative comparative analysis (QCA) was used to assess the effect of different combinations of telemedical and hospital-level resources on the timing of maternal transfers. Early (pre-33-week gestational age) maternal transfers occurred in period 1 (before the telemedicine programme started), only from areas with level-2 hospital resources and no telemedicine access; early transfers also occurred in period 2 from areas with level-2 hospital resources and either telemedicine access or no telemedicine access. We conclude that combinations of resources affect physician decisions regarding transfer and that QCA is a useful tool for examining the growth and development of telemedicine systems.
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ABSTRACT: Determine, using fuzzy set qualitative comparative analysis (fs/QCA), the relationship between patient-centered medical home (PCMH) systems and quality in 21 NCQA recognized medical homes. Primary data collected in 2009, including measures of optimal diabetes care (ODC), preventive services up-to-date (PSUTD), patient experience (PEX), survey data assessing PCMH capabilities (PPC-RS), and other clinic characteristics. Cross-sectional study identifying associations between PPC-RS domains, demographic, socioeconomic, and co-morbidity measures, and quality outcomes. PPC-RS scores were obtained by surveying clinic leaders. PSUTD and ODC scores were obtained from provider performance data. PEX data were obtained from patient surveys. Demographic, socioeconomic, and co-morbidity data were obtained from EMR and census data. fs/QCA identified associations between all three outcomes and PCMH capabilities: ODC and team-based care; PSUTD and preventive services systems; and all three outcomes and provider performance reporting systems. Previous statistical analysis of this data had failed to identify these relationships. fs/QCA identified important associations that were overlooked using conventional statistics in a small-N health services data set. PCMH capabilities are associated with quality outcomes.Health Services Research 08/2011; 47(1 Pt 1):22-45. DOI:10.1111/j.1475-6773.2011.01303.x · 2.49 Impact Factor