Results Summary and Professional Abstract
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Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- Reviewers wondered if greater stakeholder input into the study questions could have improved provider participation. The researchers said they had worked with stakeholders for many years before this study, and their stakeholders expressed as much surprise at the low participation rates as the researchers. Given space constraints, they added only a brief mention of all of their efforts to identify community priorities in dementia care.
- Reviewers noted that the initial study design became more confusing when the researchers increased the number of participating counties in the second phase, after low uptake in the first phase. In addition, by the time the second phase started, the control condition facilities were most likely affected by new mandates from the Centers for Medicare and Medicaid Services’ Partnership Initiative. Therefore, the control condition facilities were more similar to the intervention under study. The researchers acknowledged that these factors could have contributed to the lack of significant findings in the study, but they noted that by focusing on three-month outcomes they lost some sensitivity to treatment effects. After reanalyzing their data based on their original strategy using one-month outcomes, they found many more, albeit small, beneficial effects.
- Reviewers commented that although the report referenced using interrupted time series (ITS) analysis for evaluation of the standard intervention and the multi-component intervention, the results were not presented in a format typically seen with this type of analysis. The researchers confirmed that they did use ITS as the design and analysis framework. However, they explained that because of the multiple intervention time points, they used a more complicated type of ITS and were not able to provide the typical time series graphics seen in reports that use ITS.
- Reviewers asked the researchers to expand on the implications of paying providers to participate in aspects of the study, noting that this approach may limit the study’s generalizability. The researchers noted that participation was lower in the phase of the study where they offer payment to participants than in the phase where they did not offer payment. Since they therefore did not recommend payment as an incentive in this case, the researchers declined to expand on the topic other than reporting the higher participation rates in the phase of the study without provider payment.
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