Data Analysis and Production of Scholarly Output
The data were entered by optical scanner and manually verified. Quantitative data analyses were performed by Cleveland research team members in response to the initial research aims and additional questions raised by the research team and research network board. Qualitative data analyses were subcontracted to the University of Nebraska, with additional grant support from the American Academy of Family Physicians for more in-depth analyses.
Multiple papers were begun with diverse lead authorship. Preference in determining paper topics was given to methodologic manuscripts, topics with timely policy implications, and papers for which individual team members had a particular passion. In response to a call from the editorial office of JFP, a proposal for a theme issue on the DOPC Study was made and accepted. The opportunity to publish early scholarly output in one place greatly increased the potential for papers on diverse topics that would help cohesively describe several aspects of the value of family practice. The deadline for the theme issue also made the paper writing a high priority. Of 14 manuscripts accepted after going through peer review, 10 were included in the May 1998 issue of JFP,2,8-11,14,15,17,18,25,40 with one paper published in each of 4 subsequent issues.13,16,26,27 Other analyses and papers have focused on the original research themes, new topics, more complex analyses, and expansion into the non–family practice literature.
Opportunities to propose paper topics have been extended to all study participants, including the academic research team, consultants, and RAPP members. Proposed topics are reviewed for feasibility and potential conflicts with other papers. The data set has spawned 2 masters theses16,19 and one doctoral dissertation3,4,12,24 and has led to new collaborations with complementary content experts.
Related Research Initiatives
Concurrent with the DOPC study, Dr Crabtree and his colleagues in Nebraska conducted a series of related inquiries.3-5,10,12,24,39,53-56 These studies have provided complementary information and advanced multimethod approaches for studying primary care practice. Close collaboration and open information sharing among the research teams and collaborators have greatly facilitated the discovery of new methods and insights into family practice and have furthered the research trajectory of the collaborating groups. These collaborations spawned the Center for Research in Family Practice and Primary Care, a multisite consortium funded by the American Academy of Family Physicians.
DOPC Study collaborations have led to other research initiatives as well. For example, a desire for more in-depth qualitative data led to a comparative case study of a smaller number of purposively selected practices in Nebraska, funded by the AHCPR with Dr Crabtree as principal investigator. In addition, after reviewing the initial findings of the first round of DOPC data, the RAPP board of directors developed a study of competing demands outside the examination room, which has led to related inquires.
Based on emerging insights from the DOPC Study on the competing demands of family practice, a competing continuation application was funded by the NCI for a trial to improve clinical preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP) was developed with input from the research team and the RAPP board of directors, with collaboration from family practice researchers at Dartmouth, led by Allen Dietrich.57,58 Building on complexity theory–based insights from the DOPC Study,8 STEP-UP uses a multimethod practice assessment to understand the unique attributes of family practices and tailor intervention strategies. This approach increased preventive service delivery rates59 and led to a more comprehensive assessment and improvement strategy that is being evaluated in the delayed intervention group. The participants include DOPC Study practices and new RAPP members.
Continuing efforts to develop the RAPP network have included free continuing medical education conferences for participants in practice-based research and quality improvement projects. An ongoing research network newsletter periodically publishes a 1-page Research Prospectus Worksheet* to encourage research ideas from RAPP members. The Cleveland research team provides rapid turnaround methodological consultation for study proposals, and those involving multiple practices are reviewed by the RAPP board of directors. In addition, RAPP members are encouraged to serve as authors on DOPC papers, and approximately half have provided internal peer review before submission of papers.
Several RAPP members have received external funding for their own research projects. These include studies of causes of bilateral leg edema in family practice,60,61 an evaluation of a family-centered approach to diagnosis and treatment of respiratory infection, a clinical trial of therapeutic touch for carpal tunnel syndrome, and development of practical new methods for community-oriented primary care.62 A recent RAPP study, in collaboration with the NEON network, used a card study methodology to describe the “oh, by the way” phenomenon in which patients raise issues after the clinician thinks the outpatient visit is finished. In addition, the discovery of high rates of care of a secondary patient11 in the DOPC study led to an ASPN card study to elucidate the content of care provided to family members other than the identified patient for an outpatient visit.63 An additional ASPN collaboration, using the Components of Primary Care Instrument3,4 that was developed as part of the DOPC Study, examined the effect of different aspects of managed care on the delivery of 10 elements of quality primary care.64