Using multiple case studies to understand organization and patient perspectives on transitions of care between hospitals and nursing homes

Abstract

This article is intended as a practical guide for qualitative researchers. Specifically, it describes a project that employed multiple case studies to gather in-depth qualitative data for several studies focused on the interface between acute and post-acute care. We were interested in exploring, in general, how organizations in the post-acute care arena were interacting after implementation of the Affordable Care Act and, particularly, how these organizations responded to the hospital readmission penalties and other value-based reimbursement changes that were part of the Affordable Care Act. A multiple case study methodology was the most appropriate method for collecting data about these real-life, real-time events because it best illustrates how implementation occurs in specific settings. We recruited 51 organizations across eight health care markets in the United States and conducted 252 interviews with staff and patients in hospitals, nursing homes, and managed care organizations. The size and complexity of this project required perseverance in our recruiting efforts and methodical data organization.