Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions

Abstract

BackgroundThere is increasing interest in innovative methods to carry out systematic reviews of complex interventions. Theory-based approaches, such as logic models, have been suggested as a means of providing additional insights beyond that obtained via conventional review methods.MethodsThis paper reports the use of an innovative method which combines systematic review processes with logic model techniques to synthesise a broad range of literature. The potential value of the model produced was explored with stakeholders.ResultsThe review identified 295 papers that met the inclusion criteria. The papers consisted of 141 intervention studies and 154 non-intervention quantitative and qualitative articles. A logic model was systematically built from these studies. The model outlines interventions, short term outcomes, moderating and mediating factors and long term demand management outcomes and impacts. Interventions were grouped into typologies of practitioner education, process change, system change, and patient intervention. Short-term outcomes identified that may result from these interventions were changed physician or patient knowledge, beliefs or attitudes and also interventions related to changed doctor-patient interaction. A range of factors which may influence whether these outcomes lead to long term change were detailed. Demand management outcomes and intended impacts included content of referral, rate of referral, and doctor or patient satisfaction.ConclusionsThe logic model details evidence and assumptions underpinning the complex pathway from interventions to demand management impact. The method offers a useful addition to systematic review methodologies.Trial registration numberPROSPERO registration number: CRD42013004037.

Referral interventions from primary to specialist care: a systematic review of international evidence

“…With this in mind, the authors have developed a logic model to illustrate the complexity of managing this demand. 151 More research is needed to develop and evaluate interventions that acknowledge the role of the patient in the referral decision. Demand management is driven by the desire to reduce patient numbers and costs.…”

Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

“…Theoretical frameworks explain the possible relationships between concepts in general terms; logic models are usually more pragmatic illustrations of how the components of a specific programme or intervention work together to produce the desired outcomes for a particular population in a given context [25][26][27] The protocol for a mixed method review on WASH Promotion Programmes [28] presents a logic model based on the RANAS theoretical model [29], the PROGRESS framework [30] and the Checklist for Implementation (Chimp) [31]. It was refined by inviting keystakeholders to comment on the different components and the overall structure of the logic framework.…”

Enhancing the usability of systematic reviews by improving the consideration and description of interventions

“…Research with end users of reviews (including clinicians, patients, guideline developers, and policy makers) to better understand how they use review results and which details influence their choice when deciding between interventions would also be valuable. Further research is also needed into approaches, such as Qualitative Comparative Analysis 17 and logic models, 18 for identifying which configurations of intervention characteristics and contextual features 19 are critical for successful outcomes.…”