CASE STUDY DESIGN

Dr A.Kostrzewski
(Beti Wyn Evans)

LEARNING OUTCOMES
Explain what is a case study? Describe the purpose of the case study as a research tool Describe the use in research

Not the use of cases in teaching

What is it ?
INTENSIVE ANALYSIS OF A SINGLE CASE
OFTEN ONLY A PILOT PRIOR TO AN EXPERIMENTAL STUDY.

What is it ?

enquiry

in-depth examination of a single instance or event, aiming to describe and/or explain it

qualitative and/or quantitative single or multiple measured at one or multiple time points

might be separated by an event

i.e. no single method, and typically involve several methods

What is a case?

A LOCATION E.G. COMMUNITY OR ORGANISATION

A PERSON

A SINGLE EVENT

What is a case?
SINGLE CASE STUDY

Unique no others Unavailable to previous authors Pilot for a multi-case study Illustrates all the propositions of the study

TYPES OF CASES

1 research entity at 1 time point

1 entity, multiple time points

(snapshot)
(longitudinal)

1 entity, 2 time points separated by an event (pre-post) Multiple entities and designs (patchwork)

Multiple entities and designs for purpose of cross-unit comparison

VALUE OF CASE STUIDES

Address how and why questions

Can generate and/or test hypotheses

Test a theory Reveal relationships that cannot be identified by other means

Report extreme cases (e.g. case reports of side effects), or critical incidents

CRITIQUE
ADVANTAGES
Unique prompt new areas Challenge an assumed theory e.g. assume that language must be heared to be learned, but case of an isolated child learning a language Data pool to identify common factors Insight richness could not imagine the special experiences of the person studied.

DISADVANTAGES
Reliability - Generalizability Observer interaction closeness of the relationship.

Subjective selection not present all the data, only what researcher thinks is relevant.

Coolican H 2009

USE IN RESEARCH

Method used in

Social sciences Management Education Health

Used alone or as part of a multi-method approach (triangulation)

Case study example

A 77-year-old man presented with a 5-day history of painful swelling of his right elbow, which was also red, warm, and tender. When pressure was applied, a toothpastelike, white, chalky substance was easily expressible (Panel A). Four weeks earlier, palliative therapy with sorafenib had been started for metastatic renal-cell carcinoma. The patient reported that he was not taking any other medications and had no history of joint symptoms other than a compound fracture of the right elbow 30 years earlier. The serum creatinine and uric acid levels were slightly elevated Thomas W, Isabella F (2009) Gouty Tophi NEJM 361:e49,(21)

PROCESS OF CASE SUDY RESEARCH

Preparation

Is it the appropriate research method? Which approach to use? How? Developing data collection tools

Obtaining evidence

Analysing evidence Reporting

Case studies in health

Health service interventions

Practical and policy questions

Critical incidents
Examples?

EXAMPLES

How effective are smoking cessation clinics?

How were clinics implemented? Why were some clinics effective, and others not? What research methods would you use to address these questions? Is there a place for case study design?

EXAMPLES

How do pharmacists complete their CPD portfolios? How does undertaking CPD affect pharmacists practice? What is the value of portfolios to pharmacy students? (MPharm project)

EXAMPLE
Coninx R, Pfyffer GE, Methieu C et al. (1998) Drug resistant tuberculosis in prisons in Azerbaijan: case study. BMJ;316:1423-5

Aim of study:

Document existence and extent of multidrug resistance to TB medication, in a treatment centre for prisoners in Azerbaijan in which directly observed treatment was used

EXAMPLE
Method

Sputum analysis and susceptibility testing for patients not responding to 8 weeks treatment, and new cases (patients from whom sputum was obtained before starting treatment)

Results

Non-responders: 89% multidrug resistant, 0 fully susceptible New cases: 24% multidrug resistant, 32% fully susceptible

Therefore this case study identified existence and extent of multidrug resistance in the population studied

EXAMPLE
Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: a case study.

Describes barriers, facilitators bar codes to reduce errors. 10 interviews.

Nanji KC et al (2009) J Am Med Inform Assoc., Sep-Oct; 16(5): 645-50

EXAMPLE
Development of a qualitative exploratory case study research method to explore sustained delivery of cognitive services.

Inhaler Technique Applied to 7 community pharmacies

Kaae S, Sondergaard B,Haugbolle LS, Traulsen JM (2009) Pharm World Sci. Oct 13

EXAMPLE
Thrombocytopenia from combination treatment with oseltamivir and probenecid: case report, MedWatch data summary, and review of the literature.

Raisch DW, Straight TM, Holodniy M (2009) Pharmacotherapy Aug; 29(8):988-92

The earlier examples show that case studies are multifaceted

Could you use the case study method in your own MPharm research project?
Students planning a laboratory-based project talk to a peer undertaking a practice project

Summary

What is a case study? Purpose as a research tool Use in research

References
Yin RK. (2003). Case study research. Design and methods. 3rd edition. SAGE publications; London. Keen J, Packwood T (1995). Qualitative research: case study evaluation. BMJ 311;444-6.