Medicine: Mind the Gap

Increasingly, interventions are designed to operate at multiple levels, including, for example, the individual, the family, the health care provider, and the larger physical and social environment. To evaluate these multi-level interventions, investigators must plan their studies to accommodate both the extra variation associated with the multiple levels of influence and the often limited degrees of freedom available to estimate those sources of variation. Group- or cluster-randomized trials have been suggested as the gold standard for evaluation of multi-level interventions, as they have the same strengths as randomized clinical trials for interventions that involve only a single level of influence. Even so, a number of other methods have been identified as alternatives. This presentation will review the options available to evaluate multi-level interventions and will discuss their strengths and weaknesses.

Dr. Murray has spent his career evaluating intervention programs designed to improve the public health. He has worked with all age groups, in a variety of settings, and with a variety of health behaviors and disease outcomes. Beginning in the late 1980s, Dr. Murray focused on the design and analysis of group-randomized trials in which groups are randomized to conditions, and members of those groups are observed to assess the effect of an intervention. Dr. Murray wrote the first textbook on that material, published by Oxford University Press in 1998. He has worked on many of these trials, collaborating with colleagues around the country on their design, implementation, and evaluation. He has also conducted research to develop and test new methods for their design and analysis. Dr. Murray served as the first Chair of the Community-Level Heath Promotion study section, which reviews many of the prevention-related group-randomized trials submitted to the NIH. After 35 years at the University of Minnesota, the University of Memphis, and the Ohio State University, Dr. Murray joined the National Institutes of Health in September 2012 as the Associate Director for Prevention and Director of the Office of Disease Prevention. In this role, he is responsible for promoting and coordinating prevention research among and between NIH Institutes and Centers and other public and private entities. He led the development of the first Strategic Plan for the Office, which was released in February 2014. Consistent with his longstanding involvement in methodological research, one of the strategic priorities for the Office is to promote the use of the best available methods in prevention research and to support the development of better methods.

Medicine: Mind the Gap is a lecture series that explores issues at the intersection of research, evidence, and clinical practice—areas in which conventional wisdom may be contradicted by recent evidence. From the role of advocacy organizations in medical research and policy, to off-label drug use, to the effectiveness of continuing medical education, the seminar series will aim to engage the National Institutes of Health community in thought-provoking discussions to challenge what we think we know and to think critically about our role in today’s research environment.

For more information go to https://prevention.nih.gov/programs-events/medicine-mind-the-gap