Centers in the United States Megan A. Morris, PhD, MPH a Kenzie A. - PowerPoint PPT Presentation

Qualitative Research Cores in Academic Medical Centers in the United States Megan A. Morris, PhD, MPH a Kenzie A. Cameron, PhD, MPH b Rebekah Marsh, MA a Karen Kaiser, PhD b Dawn Finnie, MS c Karen Albright, PhD a,d a Anschutz Medical Campus, University of Colorado, Aurora, CO, b Northwestern University Feinberg School of Medicine, Chicago, IL, c Mayo Clinic, Rochester, MN, d University of Denver, Denver, CO

Disclosures • None to report ACCORDS – A DULT AND C HILD C ONSORTIUM FOR H EALTH O UTCOMES R ESEARCH AND D ELIVERY S CIENCE University of Colorado Denver | Anschutz Medical Campus

Background • Qualitative research has grown in acceptance and use in health services and medical sciences research • To meet the needs of investigators, academic medical centers are beginning to develop Qualitative Research Cores (QRC) – Similar mission to Biostatistical Cores – Provide consultation and collaboration for investigators across an institution

Potential Benefits of QRC • Institutional recognition of: – Value – Work required • Formalize consultations • Pooled resources • Collective action • Grantsmanship • We aimed to describe the state of QRCs in academic medical centers in the United States

Methods • Reviewed the websites of all medical schools and Clinical and Translational Services Awards (CTSA) programs in the United States from June 2017 to September 2017 – Search: “qualitative”

Methods • Included: – One or more individual who provides qualitative research support and consultation to investigators across an institution, not just with one department or program • Excluded: – Institutions where it was not evident that identified qualitative researchers did not provide service for institution – Institutions that only provided qualitative education (workshops or courses)

Methods: Data Analysis • Interviews transcribed verbatim • Three members of the research team inductively developed codebook • All transcripts were: • Double coded • Entered into Atlas.ti for data management • Coded transcripts analyzed to identify major themes • Preliminary themes presented to research participants for member checking in March 2019

Results • We identified a total of 11 QRCs – Completed 9 interviews between October 2017 and August 2018 • Location of the 9 QRCs: – 4 CTSA – 3 Centers within institution – 2 within a department

Function of the Core • Participation in grant funded projects – Small pilot grants to large, multi-year, multimillion dollar mixed-methods grants – Multiple internal and external sources (NIH, CDC, departmental funds, PCORI, foundation grants, and CTSA pilot grants) • Varied in: – Level demand (either steady or overwhelmed) – Integration within the institution

Ingredients for a Successful QRC National Acceptance Supportive Leadership Collaborations with Researchers Skilled Methodologist and Staff Administrative or “Hard M oney” Funding Support

National Acceptance • Increased acceptance and value of qualitative research within HSR • Almost all QRCs formed 2010 - 2014 – NIH Mixed Methods Report in 2010 – PCORI in 2010 – Growth of Dissemination and Implementation Research There's a real recognition that the kind of work that we do is important, especially the PCORI, implementation science (work). […] there's also a new emphasis countrywide on the sort of transdisciplinary research and the idea of not just one discipline or one approach being important on research teams.

Supportive Leadership • QRCs developed either “ground up” or “bottom down” • Identified critical need for supportive leadership and institutional buy-in What's been really helpful is having a chair that sees the value, not just in terms of dollar signs that are coming in but also sees the value of the types of research and the ability to triangulate across methods. […] he's been able to then advocate at the level of the dean and higher for additional resources and for stable resources.

Collaboration with Researchers • Relationship development with investigators across institution increases use and recognition of QRC • Successful products, grants, and published papers increases value of QRC Early on I had a couple of colleagues who had a lot of grants and basically said “this is important, let's do this.” Having collaborators who are thought leaders, it's a good thing to have. Demonstrating or having ready some pretty clear evidence, like papers or funded grants, of what this kind of approach can do can be really good too.

Collaboration with Researchers • Collaborations take time and patience – Need to educate investigators on qualitative research, including standards for rigor – Need for both collaboration and mentorship We get plenty of people who come to us without much knowledge or understanding of qualitative research. They've got a question they need to answer that they think that qualitative approach would be the best. We'd have to teach them what it is and what we do. Often I will sit and talk with them and help them define the problem better and build up their questions to sharper questions.

Skilled A 1 PhD methodologist B 1 PhD methodologist Methodologists C 1 PhD methodologist 3-4 MS/BS-level and Staff D 1-2 PhD methodologists, • PhD Methodologist 3 PhD-level – Consultations 1 PhD methodologist – Project Oversight E 1 MS-level 2-4 Undergraduate students – Minimal data collection – High-level analysis, writing F 6 analysts (3 with PhDs and 3 with MS) – “Matchmaker” 1 MD in consultative role G 4 MS-level • MS/BS 2 BS-level 1 PhD methodologist – Data collection (level depending H 5 MS-level on expertise) 2 BS-level – Assist with coding 2 PhD methodologists – Minimal (methods section) writing I 3 MS-level – Project management skills 8-10 part time MS-level people

Skilled Methodologists and Staff • Methodologists and staff need qualitative skills and ability to use skills in applied, pragmatic settings I think if you have that applied approach that's research- oriented but also recognizes the pragmatic approach that it takes to do this in a healthcare setting, that's important […] People who have those skill sets to be able to recognize, “yep, this is what needs to be done, this is the timeline, these are the methods, this is the methodology, and this is the goal that we want to achieve at the end .”

Administrative or “Hard Money” Funding Support • Staff/methodologists partially or fully grant funded for all QRC – Most frustrating and challenging part of maintaining QRC • All QRC received some protected time from the institution for administration (3 – 25%); support critical to carry out Core function The whole grant funding, grant portfolio piece is always an issue for us and making sure that we're right-sized in terms of, do we have enough time for a person's position that's funded administratively and not on grant. That's always sort of a fine balancing act that we're continuously trying to figure that out.

Conclusion • QRC similarities: – Types and sizes of projects – Types of activities • QRCs differences: – Location – Size/staffing – Demand • Despite diversity, participants identified consistent ingredients for success…

Ingredients for a Successful QRC National Acceptance Supportive Leadership Collaborations with Researchers Skilled Methodologist and Staff Administrative or “Hard M oney” Funding Support

Limitations • Perhaps missed QRCs • Not include VA • Not include QRCs that are developing or “failed” ACCORDS – A DULT AND C HILD C ONSORTIUM FOR H EALTH O UTCOMES R ESEARCH AND D ELIVERY S CIENCE University of Colorado Denver | Anschutz Medical Campus

Conclusion • Demand for qualitative research likely to continue to increase in HSR • QRCs, like biostatistical cores, are likely a way to provide high-quality qualitative research services across institutions • No one model or standard exists for how to develop and sustain a QRC • Formalization or standards for how to provide qualitative research services through a consultative core model will further promote high-quality, rigorous qualitative research

Open Faculty Positions in the Qualitative and Mixed Methods Core at University of Colorado Anschutz Medical Campus! See Megan Morris (megan.a.morris@ucdenver.edu) for additional details https://cu.taleo.net/careersection/2/jobdetail.ftl?job=16448&lang=en ACCORDS – A DULT AND C HILD C ONSORTIUM FOR H EALTH O UTCOMES R ESEARCH AND D ELIVERY S CIENCE University of Colorado Denver | Anschutz Medical Campus