Tianjing Li, MD, MHS, PhD; S. Swaroop Vedula, MD, MPH; Roberta Scherer, PhD; Kay Dickersin, MA, PhD
The authors developed and tested a framework for identifying evidence gaps and prioritizing comparative effectiveness research by using a combination of clinical practice guidelines and systematic reviews. In phase 1 of the project, reported elsewhere, 45 clinical questions on the management of primary open-angle glaucoma were derived from practice guidelines and prioritized by using a 2-round Delphi survey of clinicians. On the basis of the clinicians' responses, 9 questions were classified as high-priority. In phase 2, reported here, systematic reviews that addressed the 45 clinical questions were identified. The reviews were classified as at low, high, or unclear risk of bias, and evidence gaps (in which no systematic review was at low risk of bias) were identified. The following comparative effectiveness research agenda is proposed: Two of the 9 high-priority questions require new primary research (such as a randomized, controlled trial) and 4 require a new systematic review. The utility and limitations of the framework and future adaptations are discussed.
Figure 1. Key steps and stakeholder involvement in a framework that combines practice guidelines and systematic reviews to identify evidence gaps and prioritize comparative effectiveness research.
* Patients and consumers were not involved in this project but could be engaged in future adaptations.
Figure 2. Systematic reviews on the management of primary open-angle glaucoma that satisfied each methodological quality criterion.
* Not applicable because the reviews did not assess methodological quality or did not perform a meta-analysis.
† The denominator was the 32 systematic reviews with ≥1 meta-analysis.
Appendix Figure 1. Summary of evidence search and selection.
POAG = primary open-angle glaucoma; SR = systematic review.
* One systematic review is associated with 4 articles. A review could address >1 clinical question depending on the breadth of the review topic. Consequently, the number of clinical questions does not match the number of reviews.
Appendix Figure 2. Example of pooling data from treatment groups.
IOP = intraocular pressure. Reproduced from Holmstrom and colleagues (39) with permission of LibraPharm Ltd.
Appendix Figure 3. Example of an incorrect formula used to estimate the SD of the percentage of change in IOP from baseline.
IOP = intraocular pressure. Reproduced from Zhang and colleagues (61) with permission from the BMJ Publishing Group Ltd.
Appendix Figure 4. Example of transcription and use of an incorrect formula to estimate the SD of the percentage of change in IOP from baseline.
IOP = intraocular pressure. Reproduced from Cheng and colleagues (19) with permission. The publisher for this copyrighted material is Mary Ann Liebert, Inc. Publishers.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Li T, Vedula SS, Scherer R, Dickersin K. What Comparative Effectiveness Research Is Needed? A Framework for Using Guidelines and Systematic Reviews to Identify Evidence Gaps and Research Priorities. Ann Intern Med. 2012;156:367-377. doi: 10.7326/0003-4819-156-5-201203060-00009
Download citation file:
Published: Ann Intern Med. 2012;156(5):367-377.
High Value Care, Research and Reporting Methods.
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only