Multilevel Interventions: Study Design and Analysis Issues

Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium

“…Gaining insight into best screening processes of care within PROSPR will require multi-level investigation of patient, provider, clinic, and health system factors, and entails assembling health system information not readily available through electronic health records alone. 38,39 Clinical care pathways regarding communication of test results is one such area where the consortium is actively working to document current practices. These data will enable evaluation of the role of communication at care interfaces in the timely follow-up of screening abnormalities.…”

An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework

“…45 At present, performance ratings measure the outcomes rather than the processes of care in cancer screening decisions. 46 Thus existing performance measures for the organization may fail to capture, monitor, and reward individualized decisions. 46 Using the IDS framework, however, healthcare organizations could provide clinicians with individualized rates of screening by patient health category (using the Charlson Comorbidity Index).…”

“…46 Thus existing performance measures for the organization may fail to capture, monitor, and reward individualized decisions. 46 Using the IDS framework, however, healthcare organizations could provide clinicians with individualized rates of screening by patient health category (using the Charlson Comorbidity Index). 1,3,4 Ideally, clinicians would see high screening rates among those in good health and low screening rates among those in poor health.…”

“…Interventions to advance individual knowledge, attitudes, and behavior must be tested at the patient, clinician, and organization levels to assess independent and synergistic effects. 46 Interventions that simultaneously monitor organizational influences over time from the patient and clinician perspective will greatly reduce the gaps in standards of care. Clinical support systems that measure the timeliness of care, delivery of screening results, scheduling of diagnostic testing, safety of testing in order to avoid side effects, and patient-centeredness of care may be generalized to other clinical areas.…”

Marco conceptual y operativo del Programa de Servicios Integrados para el Empoderamiento de la Mujer

“…Las estrategias multinivel han mostrado ser más eficaces y sostenibles que los programas verticales sin integración en otros sistemas y en las comunidades, por distintas razones (Cleary, Gross, Zaslavsky, y Taplin, 2012;Schensul et al, 2015;Elkan, Masilamani y Rahman, 2008), incluyendo las siguientes:…”