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Formulation of a Strategy: A Framework for Action

Formulation of a Strategy: A Framework for Action. IOM Workshop on Standards for Systematic Reviews and Clinical Practice Guidelines May 10-11, 2011 University of California-Washington Conference Center Stephanie Chang AHRQ. Agenda. Disclaimers and Disclosures Reflections

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Formulation of a Strategy: A Framework for Action

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  1. Formulation of a Strategy: A Framework for Action IOM Workshop on Standards for Systematic Reviews and Clinical Practice Guidelines May 10-11, 2011 University of California-Washington Conference Center Stephanie Chang AHRQ

  2. Agenda • Disclaimers and Disclosures • Reflections • A Framework for action

  3. Disclaimers and Disclosures • Represent self not EPCs • Financial COI • AHRQ employee • Intellectual COI • Generalist • Academic research vs EHC program • EPC Program • Funder of systematic reviews • Government

  4. Reflections on standards • CPG have less standards, but more controversy • SR: 84 instructions, 21 standards, 4 areas • CPG: 20 instructions, 8 standards • SR considered a more mature science • In early adulthood? • From wild west to assembly line • Definition of standard • Provisional, needing beta testing • Sets an ideal or goal • Intended to provide uniformity, justification • “doesn’t mean you have to do all of them” • No minimum threshhold, no weighting

  5. Reflections on SR standards • General agreement • Areas of disagreement due to limited resources - Good science vs practicalities • Is there a minimum? • When evidence and resources are limited how to weigh values • Validity • Transparency • Patient centeredness • Timliness, efficiency, utility • Research bias? • Balance between internal and external validity – is no review better than review with potential bias or error? • Implications on need for better coordination, tools to help automate processes • May result in fewer SR, GL

  6. A framework for action • IOM work on outlining standards is done • Pilot testing • Can it work? Has this been done by any group? Is the tool too unwieldy? How much resources will it take? • Will it work? Is there face validity to the criteria? Are groups willing to implement the standards? • Is it worth it? Are SRs (or CPGs) better, more valid? Do the benefits outweigh the costs? • Uptake depends on: • Face validity and willingness by implementers • Environment that supports standards • Regulations and requirements • Funders • Publishers • ?Regulators?

  7. Evaluating the standards • Generally accepted vs variation • Limited evidence, disagreement on validity • Prioritization due to limited resources • Adopt and implement those that are agreed upon • Consider ability to gather empiric evidence • Standards to improve relevance/usefulness • Standards to improve validity • Standards to improve transparency/trustworthiness • Consider if values outweigh resource issues in areas where evidence cannot help.

  8. AHRQ work • Training materials • Training modules • Community Forum • Tools • SRDR, Abstraktr, Meta-analyst • Funded partners • GRADE workshop • CUE, Community Forum • Systematic reviews, translation guides and other dissemination materials • Post all topic nominations • Guidelines Clearinghouse, USPSTF • Methods research

  9. http://effectivehealthcare.ahrq.gov

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