Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
a PSC Research Project [ARCHIVE DISPLAY]
Investigators: Susan A. Murphy, Vijayan N. Nair
The long-term goal of this project is to improve clinical practice by facilitating the evidence-based construction of efficacious preventive interventions on high-risk or recovering individuals and treatments of drug dependent patients. Clinicians naturally adapt the level and type of therapy according to patient outcomes such as response, risk, stressors, adherence, preference and burden. This project will develop design and analysis methods for informing and enhancing this adaptive clinical practice. Adaptive interventions make this clinical practice explicit; these interventions are composed of operationalized decision rules that input patient outcomes and output recommended alterations in intensity and/or type of therapy. The construction of adaptive interventions requires addressing questions such as, "How do we best use measures of risk and other outcomes in order to decide when a patient's therapy needs to be intensified or stepped down?". "What sequence of therapies is best for achieving maximal improvement or preventing drug dependence?" and "Should this sequence of therapies vary by patient?" This project facilitates the construction of adaptive interventions by developing the following methodological innovations. First practical experimental designs that will provide data useful in constructing evidence-based adaptive interventions will be developed and refined. Second this project will improve and evaluate analysis methods that can be used with subject data in which either or both the timing of therapeutic changes and therapy alterations are randomized. These aim provides methods for addressing the questions listed above. A number of health scientists have implemented adaptive interventions in studies. A third contribution of this project will be to develop analysis methods that can be used to assess whether the alterations in therapy, made according to the decision rules, do result in improved responses. To ensure utility and receive feedback all aims involve collaborative work with health scientists interested in constructing these adaptive interventions.
|Funding:||National Institute On Drug Abuse|
Funding Period: 09/30/2005 to 08/31/2010
This PSC Archive record is displayed for historical reference.