Building a logic model of reinforced models of palliative care - PowerPoint Presentation

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Building a logic model of reinforced models of palliative care

Anke Rohwer, Andrew Booth, Lisa Pfadenhauer, Louise Brereton, Ansgar Gerhardus, Kati Mozygemba, Wija Oortwijn, Marcia Tummers, Gert Jan van der Wilt, Eva Rehfuess

The INTEGRATE-HTA project is co-funded by the European Union under the Seventh Framework Programme (Grant Agreement No.

306141)

The logic of

logic models

The

Logic of Logic ModellingComplexity of health technologies and systems

Strong assumptions about the structure, content and objectives of a health technology as well as its implementation

Negligence

of system within which the intervention is intended to act and the potential interplay and co-evolution

Describes

components

of complex interventions and relationships between them

Makes underlying theories of change and assumptions about causal pathways explicit

Describes interactions between the intervention and the system within which it is implemented

Logic Models

“…

a graphic description of a system … designed to identify important elements and relationships within that system”

.

Added value of using logic models in systematic reviews

Scoping the review

Refining review question

Deciding on lumping or splitting a review topic

Identifying intervention components

Defining and conducting the review

Identifying relevant study inclusion/exclusion criteria

Guiding the literature search strategy

Explaining the rationale behind surrogate outcomes used in the review

Justifying need for subgroup analyses (e.g. age, sex/gender, socioeconomic status)

Making the review relevant to policy and practice

Structuring reporting of results

Interpreting results based on intervention theory and systems thinking

Illustrating how harms and feasibility are connected with interventions

Interpreting results based on intervention theory and systems thinking

(Anderson et al, 2011)

Method of development

of logic models: four step process(i) systematic searches for published examples of logic models(ii) searches for existing guidance on the use of logic models in primary research, SRs and HTAs(iii) development of two draft templates for system-based and process-orientated logic models and (iv) application of these templates in three SRs and one HTA of different complex health technologies.

Logic models

in HTA and Systematic ReviewsHTA/SR research

question

Check

literature

for

published

logic models

Adoption of published

logic model

Adaptation

of logic

model

De

novo

logic

modelType of

logic model

Subtype of logic modelA-priori logic modelIterative logic model

Staged

logic

model

Process-based

logic

model

System-

based

logic

model

Three types of logic model

Label

Meaning

Type

A priori logic model

A logic model that is specified as close to the inception of an HTA or SR as scoping the literature and/or stakeholder consultation permit and that remains unchanged during the HTA/SR process.

Iterative logic model

A logic model that is subject to continual modification and revision throughout the course of an HTA or SR.

Staged logic model

A type of iterative logic model that pre-specifies points at which major data inputs are anticipated to prompt a subsequent version of the logic model, thereby increasing transparency and

minimising

problems with version control.

Subtype: System-based

logic model

Subtype: Process-oriented

logic model

Populating the

logic model template

SAP and expert input

Discussion

within

team

Literature

review

Logic models

in the INTEGRATE-HTA Process

INTEGRATE-HTA model

Ideal application of

Logic Models in INTEGRATE-HTA: Staged system-based logic model

Based on the agreed HTA question and a combination of team discussions, literature and SAPs.

Initial Logic Model

1

Based on an analysis of context and implementation, patient preferences and moderators of treatment.

Iteration 1

2

Based on the results of the effectiveness review and economic assessment, as well as insights generated through the socio-cultural, ethical and legal assessments.

Iteration 2

3

Based on any additional findings generated through an assessment of context and implementation.

Final Logic Model

4

System-based logic model of reinforced and non-reinforced home-based palliative

care (Brereton et al. 2015)

Discussion

Added valueGetting team on same pageIntegrating various types of evidence/knowledgeStructuring subsequent SR/HTA processGraphical means of communicationStrenghts and limitations:parallel development of methods and application in demonstration HTAEmpirical testing in various SREach type and subtype of logic models has its specific strengths and limitations

Conflict of Interest

The authors have no conflicts of interest to declare

<DISCLAIMER: The sole responsibility for the content of this presentation lies with the authors. It does not necessarily reflect the opinion of the European Union. The European Commission is not responsible for any use that may be made of the information contained therein.>

References

Anderson LM, Petticrew M, Rehfuess E, Armstrong R, Ueffing E, Baker P, et al. Using logic models to capture complexity in SRs. Research Synthesis Methods. 2011;2(1):33-42.Rohwer, A., Booth, A., Pfadenhauer, L., Brereton, L., Gerhardus, A., Mozygemba, K., Oortwijn, W., Tummers, M., Van Der Wilt, G.J., Rehfuess, E. (2015) Guidance on the use of logic

models

in

health

technology assessments of complex interventions [Online].

Available from: http://www.integrate-hta.eu/downloads/