The Effective Health Care Program Stakeholder Guide
Appendix E. Comparative Effectiveness Overview for Key Informants
Systematic reviews are summaries of available scientific evidence in which investigators collect, evaluate, and synthesize existing research. They use organized, structured, explicit, and transparent methodology to conduct this work. Systematic reviews are designed to provide decisionmakers with accurate, independent, scientifically rigorous information for comparing the effectiveness and safety of various health care options. Systematic reviews have become a foundation for decisionmaking in clinical practice and health policy. To play this important role in decisionmaking, they must address questions that are relevant to patients and clinicians.
Analytic Frameworks and Key Questions
Analytic frameworks are used to describe the clinical concepts and logic underlying beliefs about how interventions may improve health outcomes. Figure E-1 depicts an analytic framework for evaluating studies of a new enteral supplement to heal bedsores. There is a Key Question (KQ1, KQ2, KQ3, or KQ4) associated with each of the arrows in the analytic framework. An analytic framework helps to—
- Clarify assumptions about benefits from health care interventions, including long-term effects on quality of life, illness, and mortality.
- Be explicit about the reasoning behind clinical theories that link intermediate outcomes with outcomes of interest to patients, clinicians, and other health care decisionmakers.
- Understand the context in which clinical decisions are made and illuminate any disagreements about logic.
When available, evidence that directly links interventions to the most important health outcomes is more influential than evidence from other sources. (See KQ1 of Figure E-1.) Input from Key Informants assists with identifying and clarifying the important intermediate and long-term outcomes and the KQs that relate to those outcomes.
The KQs in the following analytic framework (Figure E-1) are—
KQ1: Does enteral supplementation improve mortality and quality of life?
KQ2: Does enteral supplementation improve wound healing?
KQ3: How frequent and severe are side effects such as diarrhea?
KQ4: Is wound healing associated with improved survival and quality of life?
Figure E-1. Analytic framework for a new enteral supplement to heal bedsores
For more information about comparative effectiveness or the Effective Health Care Program, please visit the Web site at www.effectivehealthcare.ahrq.gov.
A useful glossary of terms used in comparative effectiveness research/patient-centered outcomes research is available on the EHC Web site. Please go to www.effectivehealthcare.ahrq.gov/index.cfm/glossary-of-terms/ to access the glossary.