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Turbulence, change, fragmentation, and multiple disruptive innovations characterize the current dynamic state of health services and delivery systems in the United States. Recent efforts to redesign and transform care delivery are searching for ways to overcome the challenges of fragmentation, inequality, and inappropriate care use while advancing the triple aims of better health and better care at lower cost for everyone. Health services research can contribute to these efforts by providing valid characterizations of the complex interactions among components of the current care delivery systems and by assessing impacts of efforts to redesign and improve care delivery. Mixed methods research can help investigators fully capture the complex interactions among system components, including interactions among multiple levels of analysis and over time. Through mixed methods, researchers can identify social, organizational, technical, and market contexts that shape the course and outcomes of improvement initiatives. Use of mixed methods may also make it easier for researchers to engage in dialogues with decision makers who formulate and implement programs of delivery system change, and to better communicate with other participants in the delivery system, including its users.
Miller et al. (Tue,) studied this question.