Understanding and Evaluating Research in Applied and Clinical Settings

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by Morgan, George A

A smaller proportion of workers were employed as public relations specialists 3, , statisticians 2, , statistical clerks 1, , and urban and regional planners Sabin argues that the position of systems analyst holds great potential for applied sociologists, as it involves data processing, as well as an understanding of how organisations and businesses work. He writes,.

As far as the professional and technical workers category is concerned, Sabin sees that the general skills of a sociologist, rather than their specialist knowledge in one niche area such as the topic of their thesis , is more likely to open up employment opportunities. Applied sociological work can fit in well within any professional context; wherever people work, sociologists can help them grow by better understanding their business, their workers, their work practices, or whatever issues are of interest to their organisation.

Rather than having a narrow focus on the types of companies and groups that might hire sociologists, sociology students and the wider public need to better recognise that sociologists are employed across a multitude of business, government and private industries. Visit our Working Notes section to read articles about applied sociology written by applied sociologists, or watch our videos with applied researchers and activists.

She remains in her Adjunct position but now works as an applied sociologist elsewhere. This article was last updated 5th June added sub-headings and images. Paragraphs broken up into smaller chunks. Added Further Resources section. No text in the body of the article has been otherwise altered. Abercrombie, N. Hill and B. London: Penguin Books. Berger, P. New York: Anchor Books. Bruhn, J. New York: Plenum Press.

Burawoy, M. DeMartini, J. Freeman, H. Germov, J. Germov and M. Gouldner, A. New York: Free Press. Israel, J. Perlstadt, H. Bryant and D. Thousand Oaks: Sage Publications. Rossi, P.

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Sabin, E. Simon, R. Steele, S. Belmont: Thomson Wadsworth Publishing. As an example of the expected influence of important variables of environmental context on the success of the NCCCP pilot, the following hypotheses were developed connecting variation in levels of hospital competition and cancer services competition on the likelihood of NCCCP sites success in achieving program goals:. Hypothesis one: Pilot sites embedded with community hospitals that are in relatively weak market positions i.

This hypothesis recognizes both the important influence of the community hospital setting on achievement of program goals and direct support of the site by hospital management , and market influences that might constrain community hospital support of NCCCP activities. The more competitive the local hospital market, the less likely a host-site is to have flexible resources available to support NCCCP activities.

This hypothesis focuses on the specialized market for cancer services within the community, again recognizing that a competitive environment often constrains organizational focus and resources to 'the bottom line,' and away from innovative programming. However, competition for scarce resources can sometimes push organizations to connect cooperatively to other actors through strategic alliances to reduce uncertainty.

Further, the development of strategic linkages to other cancer service providers may be more advantageous at different stages of implementation, depending upon other characteristics of context, or histories of pre-existing linkages [ 23 ]. The application of our combined theoretical perspectives requires an evaluation design that brings into focus the ongoing structures and processes within the participating organizations and the environment within which they function, and how these structures and processes evolve over time.

The evaluation involves a phased longitudinal assessment of the pilot program over a three-year period. Figure 4 presents a matrix combining the stages of innovation implementation along the horizontal with various layers of site structure and environmental context arrayed along the vertical. Within the matrix are indicators of when observations will be taken on various variables.

The 'metrics' found in Table 2 correspond to outcome- and process-related performance indicators that are linked to evaluation hypotheses, such as the two examples above. The initial phase of the evaluation will map inter-organizational relationships within programs to project activities as well as the emergence of organizational linkages across pilot sites and between pilot sites and external organizations.

Documenting these organizational relationships involves the development of what Miles and Huberman [ 24 , 25 ] have labeled 'context charts' that locate each pilot site in its own web of reporting relationships, formal and informal communication structures, and administrative structures.

Context charts are similar to customized organizations maps, which graphically represent the interrelationships among the roles, groups, and organizations that make up the intra- and inter-organizational context of each site see Figure 2. This kind of map is important not only for describing and understanding each site within its local intra- and inter-organizational context, but also for tracking over time how well the program becomes embedded within its organizational environment.

Building on the initial assessments, evaluation metrics will be identified that correspond to site-specific work plans in the core components of the program. Special attention will be given to the appropriateness of the metrics for the evaluation questions, and the feasibility of site implementation and data collection in a manner consistent with cross-site evaluation. Based on the information collected in these two phases, a plan has been created that outlines in detail the qualitative and quantitative methods, measures, and data collection protocols that will guide the formal evaluation of the pilot program.

This evaluation will involve both a process assessment and an impact assessment of the implementation, operations, and performance of the NCCCP pilot sites. Assessing change in accrual, practice patterns and adherence to evidence-based guidelines within the limited three-year time frame of the pilot is a challenge. However, other community-based initiatives have documented significant changes within a similar time frame including increased accrual with the launch of the minority based - CCOP [ 26 ] as well as changes in clinical practice patterns attributed to various hospital-based quality improvement projects [ 27 , 28 ].

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The process assessment will evaluate the implementation experience of the specific NCCCP pilot sites, and in subsequent data collection activities through individual site assessments and comparative research. It also will assess the program improvements, best practices, and the sites' relationships to NCI-designated cancer centers and other community and national program resources.

These process assessments will be supplemented with information from patient and family member focus groups and a cross-site patient survey to elicit the performance of the program from the patients' and families' experience. The impact assessment will address a traditional set of evaluation objectives that should be fully answered and understandable once the early stages of the NCCCP and the pilot formative stages are clearly understood. The following evaluation questions will guide that analysis.

They are in large part derived from the conceptual model described above:. What changes in practice patterns, trial accrual, and adherence to evidence-based practice are attributable to the NCCCP pilot? What factors e. What program changes and associated program elements of the NCCCP pilot are likely to be sustained or institutionalized within the existing sites? Which elements appear to be dependent on unique attributes of individual sites? What is the potential for replicating these results in similar community-based cancer programs that did not participate in the NCCCP pilot?

A special component of the evaluation will be an assessment of the cost of the program.

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As a public-private partnership, the NCCCP pilot involves significant co-funding to achieve its aims. A critical evaluation question is what the 'true' cost of the NCCCP model is, and how realistic it is for the current pilot sites to sustain these program activities or any future pilot site to replicate the pilot experience.

Micro-cost analyses will include labor costs, supplies, equipment, and consulting or contract costs associated with organizational support for the NCCCP pilot. Appropriate efforts will be made to collect and allocate information on staff time spent across specific pilot activities. For the additional sources of external funding, or substantive in-kind contributions that sites contribute to the pilot activities, other external funding and the difference between total external and internal in-kind funding will be tracked.

The social case can be made if the intervention can be shown to improve quality, health status, and access to care or some other socially desirable outcome. The economic case exists if discounted financial benefits of the intervention are greater than discounted costs, even if this occurs only over a long time horizon. The business case, however, requires not only a positive financial return, but also that the potential for benefits accrue to the same entity that makes the program investment, and that benefits occur within a time frame that is short enough to be valued by that entity.

While evidence suggests that health care organizations have challenges in achieving and sustaining social, economic, or business returns in the context of program improvement initiatives [ 29 ], we hypothesize that it is the alignment of these cases in the context of program policy and implementation, rather than other characteristics of the organizations themselves, that predict these results. This assessment will be valuable in assessing the longer-term feasibility and sustainability of the NCCCP, and what changes in the program model might be necessary to better align NCI goals with the incentives and constraints facing community cancer center programs.

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NCI increasingly recognizes the critical role that multi-level systems interventions will play in improving health, both in clinical research and in clinical care. Federal research institutions are scrutinized and criticized for the limited existing initiatives that facilitate a rapid translation of research findings into clinical community and public health practice. The NCCCP, initiated as a pilot program, represents the implementation of a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the US. Its success will depend, in large part, on inter- and intra-organizational collaboration and cooperation in multiple spheres.

Assessment of the extent to which the program achieves its aims will be challenging in a three-year pilot, and will depend upon a full understanding of how individual, organizational, and environmental factors aligned or failed to align to achieve these improvements, and at what cost.

Understanding and Evaluating Research in Applied and Clinical Settings Understanding and Evaluating Research in Applied and Clinical Settings
Understanding and Evaluating Research in Applied and Clinical Settings Understanding and Evaluating Research in Applied and Clinical Settings
Understanding and Evaluating Research in Applied and Clinical Settings Understanding and Evaluating Research in Applied and Clinical Settings
Understanding and Evaluating Research in Applied and Clinical Settings Understanding and Evaluating Research in Applied and Clinical Settings
Understanding and Evaluating Research in Applied and Clinical Settings Understanding and Evaluating Research in Applied and Clinical Settings
Understanding and Evaluating Research in Applied and Clinical Settings Understanding and Evaluating Research in Applied and Clinical Settings

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