Appendix E: Guide for Key Informants

The Effective Health Care Program Stakeholder Guide

On This Page

• Topic Refinement Process: Roles and Responsibilities—A Guide for Key Informants
• Key Informant
• Comparative Effectiveness Overview for Key Informants

Topic Refinement Process: Roles and Responsibilities—A Guide for Key Informants

Evidence-based Practice Center (EPC)

EPCs are the research centers that are contracted by the AHRQ Effective Health Care (EHC) Program to conduct the research. One or more investigators from the EPC will participate on the key informant calls. The EPC will schedule and facilitate the call(s); develop the agenda; take and distribute meeting minutes; incorporate input from the key informants to develop the clear, precise draft key questions that will be posted on the Web for public comment. They also develop the analytic framework that guides the research.

Key Informant

Approximately six to nine key informants, including patients and caregivers, policymakers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience relevant to the topic will be identified to participate in the call(s). The role of the key informant group is to provide feedback on the preliminary research questions. These questions should address the issues most important to patients, caregivers, clinicians, potential guideline developers, policymakers, and other stakeholders. The input of key informants will be used to develop key questions that will guide a comparative effectiveness review on a particular topic. Individual key informants are selected because they represent a particular perspective (i.e., patient, clinician, guideline developer). Key informants are asked to represent this particular perspective throughout the topic refinement process in order to ensure a broad range of input.

AHRQ Task Order Officer (TOO)

The TOO is assigned to the topic by AHRQ and participates in all topic refinement calls. The role of the TOO is to oversee the work assignment, process, and products. The TOO is available to answer process questions and provide input regarding topic scope and definition.

John M. Eisenberg Clinical Decisions and Communications Science Center

The Eisenberg Center (EC) uses the comparative effectiveness reports to develop plain-language summary guides for clinicians, consumers, and policymakers. At least one EC representative will participate in the key informant call(s). The EC representative(s) may provide input regarding topic scope and definition, as well as other aspects of the topic refinement that may relate to the development of the final translational documents. The involvement of the EC at the topic refinement stage is intended to connect firmly the final translational documents to the initial topic refinement process. This enhances the utility ofthe translational products and increases alignment between nominator intent, actual research, and final translational products.

Scientific Resource Center (SRC)

The Scientific Resource Center (SRC) provides methodological guidance to the EPCs and conducts the initial nomination development and selection process.

Comparative Effectiveness Overview for Key Informants

Definition

Comparative effectiveness reviews (CERs) 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. CERs are designed to provide decisionmakers with accurate, independent, scientifically rigorous information for comparing the effectiveness and safety of various health care options. CERs have become a foundation for decisionmaking in clinical practice and health policy. To play this important role in decision making, CERs 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. The example in Figure 1 depicts an analytic framework for evaluating studies of a new enteral supplement to heal bedsores. There is a key question (KQ1, KQ2, KQ3, and 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 to 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 (go to Key Question 1 of Figure 1). Input from key informants will assist with identifying and clarifying the important intermediate and long-term outcomes and the key questions that relate to those outcomes.

The key questions in the example analytic framework (see Figure 1) include:

Key Question 1 (KQ1): Does enteral supplementation improve mortality and quality of life?
Key Question 2 (KQ2): Does enteral supplementation improve wound healing?
Key Question 3 (KQ3): How frequent and severe are side effects such as diarrhea?
Key Question 4 (KQ4): Is wound healing associated with improved survival and quality of life?

More Information

For more information about comparative effectiveness reviews or the Effective Health Care Program, please visit the Effective Health Care Program Web site.

A useful glossary of terms used in comparative effectiveness research is available on the EHC Program's Web site. Please go to http://effectivehealthcare.ahrq.gov/tools.cfm?tooltype=glossary to access the glossary.