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Publication bias in service delivery research: a critique - John Ovretveit

Dr John Ovretveit's critique on Dr Yen-Fu Chen's presentation on publication bias in service delivery research for the CLAHRC WM Scientific Advisory Group, 10th June 2015, Birmingham, UK

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Publication bias in service delivery research: a critique - John Ovretveit

  1. 1. Publication Bias 1 John Øvretveit, Director of Research, Professor of Health Innovation and Evaluation, Karolinska Institutet, Stockholm, Sweden 6/12/2015
  2. 2. Key points QI interventions - many sites 5-10% average - uncertain attribution = no publish But high variation between sites 1) Bias to internal validity rather than external 2) Bias against adaptive implementation action evaluation & practitioner partnership research (audit) 3) Bias to intervention research rather than descriptive explanatory & multi-method26/12/2015
  3. 3. RCT of intervention to implement guidelines for management of urinary tract infection and sore throat  Trial found average little change, But variation 36/12/2015 Why did these change so much?
  4. 4. 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 effect”  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. 46/12/2015
  5. 5. Under-used “top- and bottom- 5” analysis  Prospective theory-informed  Which sites would you expect better performance and why  Retrospective investigation  Informant’s theories  Researchers analysis  Bias against explanatory and favors quantitative statistical association  All Biases = less relevant to practitioners 5
  6. 6. 6/12/2015 6 What do you think? Surprises? My examples / experience?

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