gms | German Medical Science

GMDS 2015: 60. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

06.09. - 09.09.2015, Krefeld

Evaluation of Complex Interventions in Public Health: Assessing and Exploring Effectiveness

Meeting Abstract

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  • Ulrich Mansmann - Universität München, München, Deutschland

GMDS 2015. 60. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Krefeld, 06.-09.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocAbstr. 016

doi: 10.3205/15gmds144, urn:nbn:de:0183-15gmds1447

Veröffentlicht: 27. August 2015

© 2015 Mansmann.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

There is a general understanding that experimental approaches or surrogates for experiments to evaluate the effectiveness of interventions are the highest standard when developing an evidence base on the effectiveness of healthcare and public health interventions. These approaches are called program evaluations [1]. They assess effects of interventions by the comparison between treatment and controls but do not focus of specific parameters concerning the intervention and their context. Program evaluation contrasts structural evaluation which develop explicit models of a complex intervention and the interaction with the system in which it is implemented. Structural models are more explicit than the program evaluations approach by producing better interpretable parameters. They may help to explore why a complex intervention works or fails. While program evaluation provides good estimates for effects, structural evaluation explores ways how the complex interaction works. Building bridges between structural and program evaluation approaches is the challenge to be taken by present methodological developmentThese problems are comparable to those of systems biomedicine where the understanding of interventions into the cellular machinery assessed by randomized control trials are reinterpreted in the framework of systems biology [2].

The talk discusses the following: Use systems approaches to strengthen public health theory, to sharpen intervention concepts, and to frame the questions, additionally use advances in modern statistics to address them. Both the program evaluation approach and the structural approach have desirable features. Program evaluation approaches are generally computationally simpler than structural approaches, and it is often easier to conduct sensitivity and replication analyses with them. Identification of program effects for public health questions and the policy relevance of the treatment effects featured in the program evaluation approach are often very unclear. Structural approaches produce more interpretable parameters that are better suited to conduct counterfactual intervention analyses.

An idea from Heckman reformulated for Public Health evaluations may be: Find a third way to identify the intervention relevant combinations of structural parameters that answer well-posed intervention and public health questions. This approach often simplifies the burden of computation, facilitates replication and sensitivity analyses, and makes identification more transparent. At the same time, application of this approach forces analysts to clearly state the goals of the intervention evaluation—something many public health scientists (structural or program evaluation) have difficulty doing.

The talk summarizes some relevant aspects of the problem:

1.
Tools to conceptualize complex interventions within systems approaches
2.
Outcomes for complex interventions – concepts and measurement
3.
Methodological research concerning evaluation strategies based on non-randomized designs and developing a widely accepted evaluation framework (third way) on how to perform best evidence evaluation studies

References

1.
Heckman JJ. Building the Bridges Between Structural and Program Evaluation Approaches to Evaluating Policy. Journal of Economic Literature. 2010;48:356-398
2.
Joffe M, Gambhir M, Chadeau-Hyam M, Vineis P. Causal diagrams in systems epidemiology. Emerging Themes in Epidemiology. 2012;9:1