Download or read book Comparative Effectiveness Review Summary Guides for Clinicians written by and published by . This book was released on 2007 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Developing a Protocol for Observational Comparative Effectiveness Research A User s Guide written by Agency for Health Care Research and Quality (U.S.) and published by Government Printing Office. This book was released on 2013-02-21 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)
Download or read book Comparative Effectiveness Review Summary Guides for Consumers written by and published by . This book was released on 2005 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Comparative Effectiveness Review Summary Guides for Policymakers written by and published by . This book was released on with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Finding What Works in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-20 with total page 267 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Learning What Works written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-09 with total page 610 pages. Available in PDF, EPUB and Kindle. Book excerpt: It is essential for patients and clinicians to have the resources needed to make informed, collaborative care decisions. Despite this need, only a small fraction of health-related expenditures in the United States have been devoted to comparative effectiveness research (CER). To improve the effectiveness and value of the care delivered, the nation needs to build its capacity for ongoing study and monitoring of the relative effectiveness of clinical interventions and care processes through expanded trials and studies, systematic reviews, innovative research strategies, and clinical registries, as well as improving its ability to apply what is learned from such study through the translation and provision of information and decision support. As part of its Learning Health System series of workshops, the Institute of Medicine's (IOM's) Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss capacity priorities to build the evidence base necessary for care that is more effective and delivers higher value for patients. Learning What Works summarizes the proceedings of the seventh workshop in the Learning Health System series. This workshop focused on the infrastructure needs-including methods, coordination capacities, data resources and linkages, and workforce-for developing an expanded and efficient national capacity for CER. Learning What Works also assesses the current and needed capacity to expand and improve this work, and identifies priority next steps. Learning What Works is a valuable resource for health care professionals, as well as health care policy makers.
Download or read book Methods in Comparative Effectiveness Research written by Constantine Gatsonis and published by CRC Press. This book was released on 2017-02-24 with total page 575 pages. Available in PDF, EPUB and Kindle. Book excerpt: Comparative effectiveness research (CER) is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care (IOM 2009). CER is conducted to develop evidence that will aid patients, clinicians, purchasers, and health policy makers in making informed decisions at both the individual and population levels. CER encompasses a very broad range of types of studies—experimental, observational, prospective, retrospective, and research synthesis. This volume covers the main areas of quantitative methodology for the design and analysis of CER studies. The volume has four major sections—causal inference; clinical trials; research synthesis; and specialized topics. The audience includes CER methodologists, quantitative-trained researchers interested in CER, and graduate students in statistics, epidemiology, and health services and outcomes research. The book assumes a masters-level course in regression analysis and familiarity with clinical research.
Download or read book Comparative Effectiveness Research written by Carol M. Ashton and published by . This book was released on 2013-07-11 with total page 305 pages. Available in PDF, EPUB and Kindle. Book excerpt: Comparative Effectiveness Research: Evidence, Medicine, and Policy provides the first complete account of how — and why — the federal government decided to make comparative effectiveness research (CER) an important feature of health reform and the Affordable Care Act of 2010.
Download or read book Comparative Effectiveness Review Methods written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-17 with total page 226 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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).
Download or read book Comparative Effectiveness Review Methods written by and published by . This book was released on 2010 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVES: The Agency for Healthcare Research and Quality (AHRQ) funded the RTI International--University of North Carolina at Chapel Hill Evidence-based Practice Center to determine best practices for addressing clinical heterogeneity in systematic reviews (SRs) and comparative effectiveness reviews (CERs). These best practices address critiques from patients, clinicians, policymakers, and others who assert that SRs typically focus on broad populations and, as a result, often lack information relevant to individual patients or patient subgroups. DATA SOURCES AND METHODS: We used numerous data sources. We abstracted information from guidance documents prepared by U.S. and international organizations engaged in preparing reviews. We searched MEDLINE(r) to identify studies on how to handle clinical heterogeneity and subgroup analyses. We reviewed more than 120 SRs conducted by AHRQ's Evidence-based Practice Centers (EPCs), the Cochrane Collaboration, the Drug Effectiveness Review Project, the United Kingdom's National Institute for Health and Clinical Excellence and others that we identified from the Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effects and Health Technology Assessment. We reviewed peer and public review comments from AHRQ's Scientific Review Center for three CERs, and we conducted key informant interviews with authors of six SRs prepared by AHRQ's EPCs or international organizations. RESULTS: Clinical heterogeneity has been defined 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). Statistical heterogeneity is defined as variability in the observed treatment effects beyond what would be expected by random error. The review organizations we studied varied in their inclusion of factors, in terms of the key questions and analysis that may modify the treatment-outcome association. They tended to give more consideration to demographic factors than to disease factors (e.g., disease severity, risk factors, coexisting disease, or cointerventions). Individual systematic reviewers whom we interviewed preferred a priori identification of effect modifiers to post hoc determination because of the latter's data-dredging nature and the possibility of type 1 error when many subgroups are evaluated. Many publications that we identified through our literature searches did indicate that analysis of individual patient-level data in meta-analyses does allow better assessment of clinical heterogeneity, but the time, cost, and difficulty in obtaining these data are often prohibitive. CONCLUSIONS: Identifying factors that may influence the treatment-outcome association is important to clinicians and patients because it helps them understand which patients will benefit most, who is least likely to benefit, and who is at greatest risk of experiencing adverse outcomes. Clear evidence-based guidance on addressing clinical heterogeneity in SRs and CERs is not available currently but would be valuable to AHRQ's EPCs and to others conducting SRs internationally.
Download or read book Applying Comparative Effectiveness Data to Medical Decision Making written by Carl Asche and published by Springer. This book was released on 2015-11-30 with total page 116 pages. Available in PDF, EPUB and Kindle. Book excerpt: This textbook introduces students to the basic concepts and methods used to measure and compare the expected benefits, risks and cost of preventive and therapeutic medical interventions. It provides an easily accessible overview of comparative effectiveness and its practical applications to daily medical decisions. The book includes learning objectives for each topic, definitions of key terms and topic summaries. Each chapter is written by a highly regarded academic and extensive reference is made throughout to other sources of literature where the interested reader can find further details. The book considers, among other topics, evidence based medicine and the role of comparative effectiveness research in the development of medical guidelines, bias and confounding, quality of life, randomized controlled trials, analyses of retrospective databases, screening and economic evaluation. The book is intended to serve as a “what is it?”, “why do we need it?” and “how does it or could it effect positive change in health care?” rather than just a “how to?” technical overview. As such, it provides an essential resource for both under- and post-graduate students in health sciences.
Download or read book Initial National Priorities for Comparative Effectiveness Research written by Institute of Medicine and published by National Academies Press. This book was released on 2009-11-14 with total page 252 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. In today's healthcare system, patients, physicians, clinicians and family caregivers often lack the sufficient scientific data and evidence they need to determine the best course of treatment for the patients' medical conditions. Initial National Priorities for Comparative Effectiveness Research(CER) is designed to fill this knowledge gap by assisting patients and healthcare providers across diverse settings in making more informed decisions. In this 2009 report, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization establishes a working definition of CER, develops a priority list of research topics, and identifies the necessary requirements to support a robust and sustainable CER enterprise. As part of the 2009 American Recovery and Reinvestment Act, Congress appropriated $1.1 billion in federal support of CER, reflecting legislators' belief that better decisions about the use of health care could improve the public's health and reduce the cost of care. The Committee on Comparative Effectiveness Research Prioritization was successful in preparing a list 100 top priority CER topics and 10 recommendations for best practices in the field.
Download or read book Clinical Practice Guidelines We Can Trust written by Institute of Medicine and published by National Academies Press. This book was released on 2011-06-16 with total page 217 pages. Available in PDF, EPUB and Kindle. Book excerpt: Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.
Download or read book Comparative Effectiveness Research CER written by Francesco Chiappelli and published by . This book was released on 2016 with total page 558 pages. Available in PDF, EPUB and Kindle. Book excerpt: Briefly stated, comparative effectiveness research pertains to the direct, succinct and precise comparison of existing healthcare interventions to determine what works best for each individual patient, and which treatment course poses the greatest benefits, costs and harms. The core question of comparative effectiveness research goes beyond establishing what treatment works best, for whom, and under what circumstances: it is a hypothesis-driven endeavor designed to uncover and implement the consensus of the best evidence base for patient-centered, effectiveness-focused and evidence-based health care. Members at the Institute of Medicine and the Patient-Centered Outcomes Research concur that comparative effectiveness research involves the generation and synthesis of the best available evidence for a treatment intervention by means of a process driven by the PICOTS question/hypothesis, and are directed at comparing and contrasting the benefits, costs and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical conditions with the specified intent of improving the delivery of health care. The purpose of comparative effectiveness research is to assist healthcare providers, patients, allied clinicians, caregivers and other stakeholders to engage together and make informed decisions that will improve healthcare at both the individual and population levels, and in so doing utilize the identified best evidence base in specific clinical settings, a process that the Agency for Healthcare Research and Quality defines as "Translational Effectiveness". In brief, comparative effectiveness research is the tool and the process necessary for translational effectiveness. In this light, it is critical and timely to facilitate comparative effectiveness research as one of the essential and primary components of patient-centered, effectiveness-focused and evidence-based clinical decision-making in healthcare, as the premier process that results in improved patient outcomes, enhanced research planning, better products, and novel evidence-based policy development. This book is a compilation of the writings of several experts in the field and their collaborators. Each chapter examines specific facets of the process of comparative effectiveness research-based clinical decision-making in the principal domains of healthcare, which are subsumed in this work as dentistry, Western and alternative medicine, nursing, and pharmacology. Taken together, the chapters in this book present a brief, yet comprehensive overview and discussion of the current state of comparative effectiveness in healthcare. They establish the central role of systematic reviews in the process of clinical decision-making in evidence-based health care, and examine in depth the statistical significance and the clinical relevance of actualizing and evaluating clinical decision-making. Additionally, policies in optimizing evidence-based, patient-centered and effectiveness-focused clinical outcomes, stakeholders engagement for raising health literacy in the U.S. and worldwide in this decade of the twenty-first century and beyond are discussed.
Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.
Download or read book Comparative Effectiveness Research written by Mary A. M. Rogers Ph.D. and published by Oxford University Press. This book was released on 2013-11-04 with total page 241 pages. Available in PDF, EPUB and Kindle. Book excerpt: The last decade has seen sweeping changes in US health care policy. With more changes on the way, the emerging field of comparative effectiveness research-the science of determining how different treatments work best for different conditions-is critical for patients and clinicians who wish to make wise decisions regarding therapeutic choices. Comparative Effectiveness Research is the first textbook to offer an introduction to this topic. Written by an experienced university educator and researcher, the goal of this text is to provide readers with a gentle introduction to this diverse field. This accessible text facilitates participatory learning by including inquiries and links to web-based resources. This book will be a welcome addition to any number of courses in medicine, public health, nursing, dentistry, and allied health-or to the reference shelf of the working medical practitioner.
Download or read book Cochrane Handbook for Systematic Reviews of Interventions written by Julian P. T. Higgins and published by Wiley. This book was released on 2008-11-24 with total page 672 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
