Reporting The Findings Of Updated Systematic Reviews Of Comparative Effectiveness

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Reporting The Findings Of Updated Systematic Reviews Of Comparative Effectiveness

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Author : Sydne J. Newberry
language : en
Publisher:
Release Date : 2013

Reporting The Findings Of Updated Systematic Reviews Of Comparative Effectiveness written by Sydne J. Newberry and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.

BACKGROUND: To remain useful, comparative effectiveness reviews (CERs) and other systematic reviews require periodic updating. Although several studies have been conducted assessing when and how to update, no research has been conducted on optimal formats for presenting the results to users. The aim of the present study was to gather the input of various users of CERS regarding the usability of a range of formatting methods for showing the changes from the original to the update report. METHODS: Using the executive summaries of a comparative effectiveness review our Evidence-based Practice Center conducted in 2001 and the update review we conducted in 2008, we initially created five different versions of the update summary. Each succeeding version used a different format to show changes from the original to the update report (e.g., new and retired Key Questions, changes in search strategies and inclusion/exclusion criteria) and changes in the findings. To test the five differently formatted summaries, we identified several categories of users of CERs, convened an informal virtual focus group comprising various users, and asked them to evaluate the summaries on several dimensions, first via an email questionnaire and then in a group conference call where we presented the results of the questionnaire. Based on group feedback, we created two additional versions and tested them in a second focus group and among a third small group. The rationales for the selection of formats were two-fold: to imitate, and thus evaluate, the formats used by several organizations whose role is to conduct systematic reviews and updates and to create and test novel formats in response to users' suggestions. RESULTS: Policymakers who rely on CERs and other systematic reviews as the basis for policy (including health insurance companies, health care organizations, research funders, and guideline makers) expressed the need to see changes in review process as well as outcomes clearly marked, (with changes in outcomes and conclusions preferably shown in graphic form), while at the same time having access to the entire set of data and the analyses on which the conclusions were based. The small group of clinicians preferred to see the skeleton of the report (Key Questions, conceptual framework, inclusion/exclusion criteria) as well as the outcomes and conclusions presented entirely in graphic form for ease of reading. CONCLUSIONS: Different users of CERs clearly have different information needs. Yet whereas policymakers need access to the entire data set and analyses that comprise a systematic review (the original and the update), all users benefit from summaries that clearly show what changed in as succinct a format as possible, preferable in graphic form.

Finding What Works In Health Care

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Author : Institute of Medicine
language : en
Publisher: National Academies Press
Release Date : 2011-07-20

Finding What Works In Health Care written by Institute of Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-07-20 with Medical categories.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

Finding What Works In Health Care

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Author : Institute of Medicine
language : en
Publisher: National Academies Press
Release Date : 2011-06-20

Finding What Works In Health Care written by Institute of Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-06-20 with Medical categories.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

Knowing What Works In Health Care

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Author : Institute of Medicine
language : en
Publisher: National Academies Press
Release Date : 2008-05-29

Knowing What Works In Health Care written by Institute of Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-05-29 with Medical categories.

There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. The United States must substantially strengthen its capacity for assessing evidence on what is known and not known about "what works" in health care. Even the most sophisticated clinicians and consumers struggle to learn which care is appropriate and under what circumstances. Knowing What Works in Health Care looks at the three fundamental health care issues in the United States-setting priorities for evidence assessment, assessing evidence (systematic review), and developing evidence-based clinical practice guidelines-and how each of these contributes to the end goal of effective, practical health care systems. This book provides an overall vision and roadmap for improving how the nation uses scientific evidence to identify the most effective clinical services. Knowing What Works in Health Care gives private and public sector firms, consumers, health care professionals, benefit administrators, and others the authoritative, independent information required for making essential informed health care decisions.

Comparative Effectiveness Review Methods

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Author : U. S. Department of Health and Human Services
language : en
Publisher: Createspace Independent Pub
Release Date : 2013-05-17

Comparative Effectiveness Review Methods written by U. S. Department of Health and Human Services and has been published by Createspace Independent Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-05-17 with Medical categories.

The Agency for Healthcare Research and Quality (AHRQ) commissioned the RTI International–University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center (EPC) to explore how systematic review groups have dealt with clinical heterogeneity and to seek out best practices for addressing clinical heterogeneity in systematic reviews (SRs) and comparative effectiveness reviews (CERs). Such best practices, to the extent they exist, may enable AHRQ's EPCs to address critiques from patients, clinicians, policymakers, and other proponents of health care about the extent to which “average” estimates of the benefits and harms of health care interventions apply to individual patients or to small groups of patients sharing similar characteristics. Such users of reviews often assert that EPC reviews typically focus on broad populations and, as a result, often lack information relevant to patient subgroups that are of particular concern to them. More important, even when EPCs evaluate literature on homogeneous groups, there may be varying individual treatment for no apparent reason, indicating that average treatment effect does not point to the best treatment for any given individual. Thus, the health care community is looking for better ways to develop information that may foster better medical care at a “personal” or “individual” level. To address our charge for this methods project, the EPC set out to answer six key questions (KQ). Key questions for methods report on clinical heterogeneity include: 1. What is clinical heterogeneity? a. How has it been defined by various groups? b. How is it distinct from statistical heterogeneity? c. How does it fit with other issues that have been addressed by the AHRQ Methods Manual for CERs? 2. How have systematic reviews dealt with clinical heterogeneity in the key questions? a. What questions have been asked? b. How have they pre-identified population subgroups with common clinical characteristics that modify their intervention-outcome association? c. What are best practices in key questions and how these subgroups have been identified? 3. How have systematic reviews dealt with clinical heterogeneity in the review process? a. What do guidance documents of various systematic review groups recommend? b. How have EPCs handled clinical heterogeneity in their reviews? c. What are best practices in searching for and interpreting results for particular subgroups with common clinical characteristics that may modify their intervention-outcome association? 4. What are critiques in how systematic reviews handle clinical heterogeneity? a. What are critiques from specific reviews (peer and public) on how EPCs handled clinical heterogeneity? b. What general critiques (in the literature) have been made against how systematic reviews handle clinical heterogeneity? 5. What evidence is there to support how to best address clinical heterogeneity in a systematic review? 6. What questions should an EPC work group on clinical heterogeneity address? Heterogeneity (of any type) in EPC reviews is important because its appearance suggests that included studies differed on one or more dimensions such as patient demographics, study designs, coexisting conditions, or other factors. EPCs then need to clarify for clinical and other audiences, collectively referred to as stakeholders, what are the potential causes of the heterogeneity in their results. This will allow the stakeholders to understand whether and to what degree they can apply this information to their own patients or constituents. Of greatest importance for this project was clinical heterogeneity, which we define as the variation in study population characteristics, coexisting conditions, cointerventions, and outcomes evaluated across studies included in an SR or CER that may influence or modify the magnitude of the intervention measure of effect (e.g., odds ratio, risk ratio, risk difference).

Assessment Of The Need To Update Comparative Effectiveness Reviews

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Author :
language : en
Publisher:
Release Date : 2009*

Assessment Of The Need To Update Comparative Effectiveness Reviews written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009* with categories.

AHRQ recognizes that periodic assessments of the evidence base supporting each of the comparative effectiveness reviews is an important and necessary part of the Effective Health Care (EHC) Program. The rapidity with which new research findings accumulate makes it imperative that the evidence be assessed periodically to determine the need for a full-scale update. The EHC Program, then, initiated concurrent and parallel work to address this need both methodologically and programmatically. The development of methods guidance for updating was initiated to inform the research of systematic reviewers. This methodologic guidance will supplement the EHC Methods Guide for Comparative Effectiveness Reviews (www.effectiveheathcare.gov). In parallel with the methods effort, an initial, rapid program assessment was commissioned to assess the need for the findings of the CERs completed to that point to be updated. The Southern California Evidence-based Practice Center (SCEPC) was tasked with conducting this assessment. Findings from the assessment were presented to AHRQ for consideration within the usual program criteria to prioritize the topics for updating within the EHC Program. This document presents the findings from the assessment for public information and transparency.

Systematic Reviews To Answer Health Care Questions

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Author : Heidi D. Nelson
language : en
Publisher: Lippincott Williams & Wilkins
Release Date : 2014-05-29

Systematic Reviews To Answer Health Care Questions written by Heidi D. Nelson and has been published by Lippincott Williams & Wilkins this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-05-29 with Medical categories.

Systematic Evidence Reviews to Answer Health Care Questions is your most effective, A-to-Z guide to conducting thorough, comprehensive systematic reviews. By breaking down topics and essential steps, this volume teaches you how to form key questions, select evidence, and perform illuminating review not just in predictable circumstances, but when basic rules don’t apply—honing your ability to think critically and solve problems. You’ll learn how to define a review’s purpose and scope, develop research questions, build a team, and even manage your project to maximize efficacy. If you’re looking to refine your approach to systematic reviews, don’t just catalog and collect; use this powerful text to evaluate, synthesize, and deliver results that will help shape the health care industry. FEATURES Presented in standard format throughout to allow for more practical, easy to read approach Provides useful instruction on how to conduct a high-quality systematic review that meets the recent standards of the Institute of Medicine Accessible, concise information about the state-of-the-art methods of systematic review, from key question formulation to assessing the quality of included studies and reporting results Illustrated throughout with real-world examples from systematic reviews that have been used to inform practice guidelines and health policy

Systematic Reviews

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Author :
language : en
Publisher:
Release Date : 2009

Systematic Reviews written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009 with Electronic books categories.

For adults. There is a pressing need for methodologically sound RCTs to confirm whether such interventions are helpful and, if so, for whom.

Cochrane Handbook For Systematic Reviews Of Interventions

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Author : Julian P. T. Higgins
language : en
Publisher: Wiley
Release Date : 2008-11-24

Cochrane Handbook For Systematic Reviews Of Interventions written by Julian P. T. Higgins and has been published by Wiley this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-11-24 with Medical categories.

Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com). The Cochrane Handbook for Systematic Reviews of Interventions contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.

Assessment Of A Method To Detect Signals For Updating Systematic Reviews

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Author : Paul G. Shekelle
language : en
Publisher:
Release Date : 2014

Assessment Of A Method To Detect Signals For Updating Systematic Reviews written by Paul G. Shekelle and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014 with categories.

BACKGROUND: Systematic reviews are a cornerstone of evidence-based medicine. The Agency for Healthcare Research and Quality (AHRQ) has a program to produce systematic reviews. Systematic reviews will become out of date as new evidence gets published. Determining when a systematic review has gone sufficiently out of date to warrant an update is challenging. AHRQ has a surveillance system that uses limited literature searches and expert opinion to detect signals for when a systematic review is out of date. While the surveillance system has face validity, an assessment of predictive validity has not been performed METHODS: The AHRQ Comparative Effectiveness Review (CER) program had produced 13 CERs by 2009, and 11 of these were assessed in 2009 using the surveillance system to produce determinations of the degree to which individual conclusions were out of date, along with a priority for updating each report. Four CERs were judged to be a high priority for updating, 4 CERs were judged to be medium priority for updating, and 3 CERs were judged to be low priority for updating. AHRQ then commissioned full updated reviews for 9 of these 11 CERs, including 4 high, 3 medium, and 2 low-priority reports. After all the updated reports were completed, we matched the original predictions about which conclusions in each CER were still valid, possibly out of date, probably out of date, and out of date, with the corresponding conclusions in the updated report, and then classified each pair as having good, fair or poor concordance. We also made a summary determination of the priority for updating each CER based on the actual changes in conclusions in the updated report, and compared these determinations with the earlier assessments of priority. RESULTS: The 9 CERs included nearly 150 individual conclusions. In 8 of the 9 reports, the great majority of assessments of individual conclusions had good concordance between the predictions and the update. Across reports, 83 percent of matched conclusions had good concordance, and 99 percent had good or fair concordance. For 16 percent of conclusions there was either no match between the original and updated report, or the concordance assessment was otherwise not applicable. There was one instance of poor concordance, and the publication of new evidence after the surveillance signal searches had been done contributed to the changed conclusion in the updated report. This occurred in a CER already judged as being a high priority for updating. For one CER originally judged as being high priority for updating, based on the actual updated results we judged it as having been a medium priority. For another CER originally judged as being medium priority for updating, based on the actual updated results we judged it as having been a high priority. The remaining 7 CERs had agreement between their assessments of priority status. Both CERs originally judged as being low priority for updating had no substantive changes to their conclusions in the actual updated report. The agreement on overall priority for updating between prediction and actual changes to conclusions was K=0.74. CONCLUSIONS: These results provide some support for the surveillance system's validity for detecting signals of when a systematic review is sufficiently out of date that it needs updating.