Level 1 concerns individual health outcomes, level 2 concerns the effect of one-person's behaviour on another (e.g., doctor patient interaction, other regarding preferences) and level 3 specific organizational effects (e.g., turnover) in this context of health care provision.
Because of the hierarchical structure of the data, multilevel analysis was applied that took into account the dependence between patient outcomes (level 1) within primary care practices (level 2).
The framework described levels of capability that could be used to evaluate progress toward each indicator, categorizing capabilities as prerequisites/foundational (level <1), inputs and processes (level 1), outputs and outcomes (level 2), and additional (level 3).
However, as the review aimed to gain a broad perspective of the effectiveness of donepezil on outcomes, level 3 and 4 evidence was also assessed, particularly where level 1 and 2 evidence was lacking or conflicting.
The component of the model that extends its utility to the clinical outcomes level by predicting changes induced in LSBMD includes on- and off-treatment observations and a robust range of doses and regimens of denosumab.
A positive attitude of trainees, as represented by the first level of Kirkpatrick's model for evaluation of a training, should result in a learning effect (Kirkpatrick level two) and behavioural change (level three) and finally be translated in patient outcomes (level four) [ 35].
