1 / 8

In Search of Synergy: Strategies for Combining Interventions at Multiple Levels

In Search of Synergy: Strategies for Combining Interventions at Multiple Levels. Bryan J. Weiner, Ph.D. Megan A. Lewis, Ph.D. Steven B. Clauser, Ph.D. Karyn Stitzenberg, M.D. Problem/Approach.

regis
Download Presentation

In Search of Synergy: Strategies for Combining Interventions at Multiple Levels

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. In Search of Synergy: Strategies for Combining Interventions at Multiple Levels Bryan J. Weiner, Ph.D. Megan A. Lewis, Ph.D. Steven B. Clauser, Ph.D. Karyn Stitzenberg, M.D.

  2. Problem/Approach • How can we combine interventions at different levels to produce complementary/synergistic effects? • We used a causal modeling framework • Focused on two types of interdependence • Identified 5 strategies • Illustrated with interventions at multiple levels to improve the quality of treatment for locally-advanced rectal cancer

  3. Accumulation Strategy Public reporting* (organizational) Opinion leader (interpersonal) Physician motivation Chemoradiationtherapy Outreach visit (intrapersonal) Legend:Box: intervention and level of influence (in parentheses) Diamond: mediatorOval: outcome *For expositional purposes, the diagram depicts interventions rather than determinants as causes. Public reporting in this instance refers to the publication of practice-level CRT rates. To keep the presentation simple, a single mediating pathway is presented.

  4. Amplification Strategy Public reporting* (organizational) Physician motivation Chemoradiationtherapy Opinion leader (interpersonal) Reimbursement(intrapersonal)

  5. Facilitation Strategy Public reporting* (organizational) Physician motivation Chemoradiationtherapy Opinion leader (interpersonal) Clinical Reminder(intrapersonal)

  6. Cascade Strategy Physician/ Managermotivation Advocacy (policy) Tumor Board(organizational) Multi-Disciplinary Planning Physician motivation Opinion leader (interpersonal) Chemoradiationtherapy

  7. Convergence Strategy Public reporting* (organizational) Physician motivation Opinion leader (interpersonal) Physician - PatientInteraction Patient Education(intrapersonal) Patient motivation Chemoradiationtherapy

  8. Discussion Questions • Do we have theories that explain how determinants at multiple levels interact to produce health and other outcomes? • Do we have enough cross-level research that examines the interdependence of variables (determinants) at multiple levels of influence? • Do we have sufficient grasp of the causal mechanisms through which commonly employed interventions produce their effects?

More Related