Non-Experimental Designs of Health Services Research:

Description:This assignment asks you to put yourself in a decision-making role over what kind of intervention would be most appropriate for a given scenario. In your position you will have to consider the clinical indicator of interest (mammography rates), the population being served (Medicare women, many of whom suffer from kidney failure and/or mental illness), and the interventions being considered (posters, mailers, or small group seminars). You are to prepare a report to the board evaluating the limitations of the project and each of the interventions. You are to recommend one intervention to pursue and provide a rationale for your decision.

Scenario:You and your partner oversee a community based health alliance that has received funding to improve mammography rates for women in your community. The funding source is particularly interested in addressing the needs of women who are Medicare beneficiaries. Accordingly, you want to conform to the Centers for Medicare and Medicaid Services (CMS) Physicians Quality Reporting System (PQRS) measure specification and criteria.

After reviewing the CMS documents you realize that the mammography measure is defined for women between the ages of 40 and 69. Medicare beneficiaries are primarily those 65 years of age and older. However, in the 1970s Medicare extended coverage to include those who have end stage renal disease (kidney failure) and those who have certain disabilities. The most common type of disability in this population is mental illness. Given the characteristics of the target population, you realize that the mammography campaign has substantial limitations. On the upside, the funding source has access to beneficiary level data from CMS. After careful consideration, you have identified two interventions that the alliance may pursue:

1. A community-wide campaign consisting of placing educational posters in high traffic areas.
2. A series of educational workshops targeting women in the community who meet the mammography measures eligibility criteria.

You only have resources to select one of the interventions and have been given a timeline for completion of 18 months. Prepare a brief report to the alliance board with a recommendation for one of the interventions. Your report should have the following sections:

BACKGROUND explain the purpose of the mammography measure in broad terms drawing from your understanding of the measure from reading the Measure Specification Manual.

ForBOTHof the interventions, address the following:

• METHOD describe at least one methodological issue related to each intervention that may arise when dealing with the target population.
• ASSIGNMENT describe at least one methodological issue related to each intervention that may arise when attempting to assign participants to a study group or a control group.
• ASSESSMENT describe at least one methodological issue related to each intervention that may arise when attempting to assess the outcomes of the experiment (e.g., the study group versus the control group).
• RESULTdescribeatleastonemethodologicalissueforeachinterventionthatmayariseinattemptingtocomparetheresultsfromthestudyandcontrolgroups.
• Finally, conclude with a recommendation. Based on your evaluation of the interventions, select the intervention that you feel presents the fewest methodological concerns and which can be most effectively analyzed. Provide a rationale for your selection.