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#1 PPT/min;#aidience guess needs to do #objectives, outline, , (Reason Sequence examples) #dont dumb down #examples #Summary points; #resources
bias - average not pub but wide variation - explain - not published retrospective and less certain - bias to internal validity rather than external Unconcern about relevance to settings different to those of the study with fewer implementation resources or populations requiring adaption - bias against adaptive implementation research using action evaluation and participant collected data
Short electronic version and a laminated summary of the main recommendations Patient educational material in electronic and printed formats Computer-based decision support and reminders An increase in the fee for telephone consultations for these two diagnoses Printed material to facilitate discussions in the practice about routines and change Interactive courses for GPs and assistants
Data from 120 practices: observations, semi-structured telephone interviews, a postal survey and data extracted from electronic medical records. Investigated factors that might explain lack of change and variation: agreement with guidelines; communication within each practice; degree of participation in the project; taking time to discuss the guidelines and their implementation; use of the components of the interventions; and routines for telephone consultations.
Flottorp S, Havelsrud K, Oxman AD. Process evaluation of a cluster randomized trial of tailored interventions to implement guidelines in primary care — why is it so hard to change practice? Fam Pract 2003; 20: 333-339. Flottorp S, Oxman AD, Havelsrud K, Treweek S, Herrin J. Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat. Br Med J 2002; 325: 367. Flottorp S, Oxman AD. Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods. BMC Health Services Research 2003; 3:3.
Publication bias in service delivery research: a critique - John Ovretveit
Director of Research, Professor of Health Innovation and
Evaluation, Karolinska Institutet, Stockholm, Sweden
QI interventions - many sites
5-10% average - uncertain attribution = no publish
But high variation between sites
1) Bias to internal validity rather than
2) Bias against adaptive implementation
& practitioner partnership research (audit)
3) Bias to intervention research rather than
descriptive explanatory & multi-method26/12/2015
RCT of intervention to implement guidelines for
management of urinary tract infection and sore throat
Trial found average little change, But variation
Process evaluation in parallel to RCT
“A combination of organizational problems
… and lack of time and engagement
…is the most viable explanation for the lack of
agreement with guidelines;
degree of participation in the project;
taking time to discuss the guidelines and their implementation;
use of the components of the interventions;
procedures for telephone consultations;
communication within each practice.
Under-used “top- and bottom- 5” analysis
Which sites would you expect better performance and why
Bias against explanatory and favors
quantitative statistical association
All Biases = less relevant to
What do you think?
My examples / experience?