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1 | INTRODUCTION Designing practical decision support tools and other types of health care technology for implementation science and quality improvement relies on a clear understanding of the cognitive processes [...], Objective: Designing practical decision support tools and other health care technology in health services research relies on a clear understanding of the cognitive processes that underlie the use of these tools. Unfortunately, methods to explore cognitive processes are rarely used in health services research. Thus, the objective of this manuscript is to introduce cognitive task analysis (CTA), a family of methods to study cognitive processes involved in completing a task, to a health services research audience. This methods article describes CTA procedures, proposes a framework for their use in health services research studies, and provides an example of its application in a pilot study. Data Sources and Study Setting: Observations and interviews of health care providers involved in discharge planning at six hospitals in the Veterans Health Administration. Study Design: Qualitative study of discharge planning using CTA. Data Collection/Extraction Methods: Data were collected from structured observations and semi-structured interviews using the Critical Decision Method and analyzed using thematic analysis. Principal Findings: We developed an adaptation of CTA that could be used in a clinical environment to describe clinical decision-making and other cognitive processes. The adapted CTA framework guides the user through four steps: (1) Planning, (2) Environmental Analysis, (3) Knowledge Elicitation, and (4) Analyses and Results. This adapted CTA framework provides an iterative and systematic approach to identifying and describing the knowledge, expertise, thought processes, procedures, actors, goals, and mental strategies that underlie completing a clinical task. Conclusions: A better understanding of the cognitive processes that underly clinical tasks is key to developing health care technology and decision-support tools that will have a meaningful impact on processes of care and patient outcomes. Our adapted framework offers a more rigorous and detailed method for identifying task-related cognitive processes in implementation studies and quality improvement. Our adaptation of this underutilized qualitative research method may be helpful to other researchers and inform future research in health services research. KEYWORDS care coordination, cognitive task analysis, discharge planning, qualitative research, surgery

The majority of health services research focuses on health care-access to it, utilization of it, outcomes from it, and, importantly, disparities in it. Yet, health services research is much broader [...]

1 | INTRODUCTION Referrals from primary care physicians (PCP) to specialists and among different specialists and subspecialists are important contributors to medical care costs and quality. (1,2) Referrals have increased [...], Objective: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, | compare referral patterns of PCPs in rural vs nonrural areas. Data Collection: Multiple years of data were combined. Principal Findings: A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression-adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013-2014 and 92 percent higher in 2015-2016. Conclusions: Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions. KEYWORDS ambulatory care, physician practice patterns, referrals, rural

The task of determining the practice population in fee-for-service practice has challenged health services researchers for the better part of two decades. Kilpatrick (1984a) has defined a practice population as [...]

Federal funding is insufficient to support all of the essential health services research (HSR) that the government deems worthy. Federal funds must be supplemented by private sector grants and by [...]

The goal of small area analysis is often to demonstrate that hospital admission rates or procedure rates vary greatly among regions, suggesting the occurrence of unnecessary admissions or procedures in [...]