Building a logic model of reinforced models of

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 Modelling Complexity of health technologies and systems Describes components of complex interventions and relationships between them Strong assumptions about the Logic Models Makes underlying theories of change a graphic structure, content and “… objectives of description of a system … and assumptions about causal to identify important a health technology asdesigned well as its pathways explicit elements and relationships within that implementation system”. Negligence of system within which the intervention is intended to act and the potential interplay and coevolution Describes interactions between the intervention and the system within which it is implemented

Added value of using logic models in systematic reviews Scoping the review Defining and conducting the review Making the review relevant to policy and practice • Refining review question • Deciding on lumping or splitting a review topic • Identifying intervention components • • 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) • • 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 systembased 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 Reviews HTA/SR research question Check literature for published logic models Adoption of published logic model Adaptation of logic model De novo logic model Type of logic model A-priori logic model Iterative logic model Staged logic model Subtype of logic model Process-based logic model System-based logic model

Three types of logic model Label Meaning A priori logic A logic model that is specified as close to the inception of an HTA or SR as scoping the model literature and/or stakeholder consultation permit and that remains unchanged during the Type HTA/SR process. Iterative A logic model that is subject to continual modification and revision throughout the course logic model of an HTA or SR. Staged logic A type of iterative logic model that pre-specifies points at which major data inputs are model 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 Literature review SAP and expert input Discussion within team

Logic models in the INTEGRATEHTA Process

INTEGRATE-HTA model

Ideal application of Logic Models in INTEGRATE-HTA: Staged system-based logic model 1 2 3 Based on the agreed HTA question and a combination of team discussions, literature and SAPs. Based on an analysis of context and implementation, patient preferences and moderators of treatment. Based on the results of the effectiveness review and economic assessment, as well as insights generated through the sociocultural, ethical and legal assessments. Initial Logic Model Iteration 1 Iteration 2 4 Based on any additional findings generated through an assessment of context and implementation. Final Logic Model

Systembased logic model of reinforced and nonreinforced home-based palliative care (Brereton et al. 2015)

Discussion • Added value – Getting team on same page – Integrating various types of evidence/knowledge – Structuring subsequent SR/HTA process – Graphical means of communication • Strenghts and limitations: – parallel development of methods and application in demonstration HTA – Empirical testing in various SR – Each 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. integratehta. eu/downloads/