TY - JOUR
T1 - Improving the utility of evidence synthesis for decision makers in the face of insufficient evidence
AU - Murad, M. Hassan
AU - Chang, Stephanie M.
AU - Fiordalisi, Celia V.
AU - Lin, Jennifer S.
AU - Wilt, Timothy J.
AU - Tsou, Amy Y.
AU - Leas, Brian
AU - Siddique, Shazia
AU - Zullo, Andrew R.
AU - Balk, Ethan M.
AU - Rutter, Carolyn M.
AU - Robinson, Karen
AU - Coleman, Craig
AU - Costa, Olivia
AU - Helfand, Mark
AU - Stoeger, Elizabeth
AU - Viswanathan, Meera
N1 - Funding Information:
Funding: This work was funded by the Agency for Healthcare Research and Quality through the following contracts: Scientific Resource Center (290-2017-00003-C), Mayo Clinic EPC (290-2015-00013-I), University of Minnesota EPC (290-2015-00008-I), Kaiser Permanente Research Affiliates EPC (290-2015-00007-I), RTI-University of North Carolina EPC (290-2015-00011-I), Southern California/RAND EPC (290-2015-00010-I), Brown University EPC (290-2015-00002-I), ECRI Institute-Penn Medicine EPC (290-2015-00005-I), University of Connecticut EPC (290-2015-00012-I), and Johns Hopkins University EPC (290-2015-00006-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Funding Information:
Funding: This work was funded by the Agency for Healthcare Research and Quality through the following contracts: Scientific Resource Center ( 290-2017-00003-C ), Mayo Clinic EPC ( 290-2015-00013-I ), University of Minnesota EPC ( 290-2015-00008-I ), Kaiser Permanente Research Affiliates EPC ( 290-2015-00007-I ), RTI- University of North Carolina EPC ( 290-2015-00011-I ), Southern California / RAND EPC ( 290-2015-00010-I ), Brown University EPC ( 290-2015-00002-I ), ECRI Institute-Penn Medicine EPC ( 290-2015-00005-I ), University of Connecticut EPC ( 290-2015-00012-I ), and Johns Hopkins University EPC ( 290-2015-00006-I ). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Publisher Copyright:
© 2021 The Authors
PY - 2021/7
Y1 - 2021/7
N2 - Objective: To identify and suggest strategies to make insufficient evidence ratings in systematic reviews more actionable. Study Design and Setting: A workgroup comprising members from the Evidence-Based Practice (EPC) Program of the Agency for Healthcare Research and Quality convened throughout 2020. We conducted iterative discussions considering information from three data sources: a literature review for relevant publications and frameworks, a review of a convenience sample of past systematic reviews conducted by the EPCs, and an audit of methods used in past EPC technical briefs. Results: We identified five strategies for supplementing systematic review findings when evidence on benefits or harms is expected to be, or found to be, insufficient: 1) reconsider eligible study designs, 2) summarize indirect evidence, 3) summarize contextual and implementation evidence, 4) consider modelling, and 5) incorporate unpublished health system data in the evidence synthesis. While these strategies may not increase the strength of evidence, they may improve the utility of reports for decision makers. Adopting these strategies depends on feasibility, timeline, funding, and expertise of the systematic reviewers. Conclusion: Throughout the process of evidence synthesis of early scoping, protocol development, review conduct, and review presentation, authors can consider these five strategies to supplement evidence with insufficient rating to make it more actionable for end-users.
AB - Objective: To identify and suggest strategies to make insufficient evidence ratings in systematic reviews more actionable. Study Design and Setting: A workgroup comprising members from the Evidence-Based Practice (EPC) Program of the Agency for Healthcare Research and Quality convened throughout 2020. We conducted iterative discussions considering information from three data sources: a literature review for relevant publications and frameworks, a review of a convenience sample of past systematic reviews conducted by the EPCs, and an audit of methods used in past EPC technical briefs. Results: We identified five strategies for supplementing systematic review findings when evidence on benefits or harms is expected to be, or found to be, insufficient: 1) reconsider eligible study designs, 2) summarize indirect evidence, 3) summarize contextual and implementation evidence, 4) consider modelling, and 5) incorporate unpublished health system data in the evidence synthesis. While these strategies may not increase the strength of evidence, they may improve the utility of reports for decision makers. Adopting these strategies depends on feasibility, timeline, funding, and expertise of the systematic reviewers. Conclusion: Throughout the process of evidence synthesis of early scoping, protocol development, review conduct, and review presentation, authors can consider these five strategies to supplement evidence with insufficient rating to make it more actionable for end-users.
KW - Decision-making
KW - Health systems
KW - Insufficient evidence
KW - Systematic reviews
KW - Translation
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U2 - 10.1016/j.jclinepi.2021.02.028
DO - 10.1016/j.jclinepi.2021.02.028
M3 - Article
C2 - 33753229
AN - SCOPUS:85103928066
SN - 0895-4356
VL - 135
SP - 170
EP - 175
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -