Towards a Framework for Communicating Confidence in Methodological Recommendations for Systematic Reviews and Meta-Analyses – AHRQ – September 2013

Posted on October 23, 2013. Filed under: Research | Tags: , , |

Towards a Framework for Communicating Confidence in Methodological Recommendations for Systematic Reviews and Meta-Analyses – AHRQ – September 2013

Trikalinos TA, Dahabreh IJ, Wallace BC, Schmid CH, Lau J. Towards a Framework for Communicating Confidence in Methodological Recommendations for Systematic Reviews and Meta-Analyses. Methods Research Report. (Prepared by Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I). AHRQ Publication No. 13-EHC119-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2013

“Abstract

We propose a framework for organizing and describing the rationale behind methodological recommendations, and for communicating one’s confidence in them. We start by defining the background context in which the recommendations are made. We distinguish recommendations that are testable (in that their likelihood to hold can be informed by theoretical arguments or empirical data) from nontestable ones, which represent beliefs or assumptions that are not verifiable. Nontestable statements can be justified, but their validity cannot be demonstrated. Testable statements can be assessed in terms of the adequacy of their evidentiary basis.

Both testable and nontestable statements can be evaluated regarding their feasibility of implementation, the expected impact of following them versus not, and their congruence with the desired characteristics of the background context. Considering these four dimensions, one can indicate one’s confidence (along a continuum) about how closely a methods recommendation should be followed: some recommendations may be perceived and communicated as mandatory items (minimum standards), while others as highly desirable but not mandatory items. Finally, giving specific methods guidance for addressing difficult or ill-defined problems can be premature pending more research or clearer problem specification. In such cases, describing the problem and laying out attributes of a satisfactory resolution can serve until actionable guidance can be offered.

We view the proposed framework strictly as a communication tool to describe rationale for the recommendations to the intended audience and not as a device to deduce the “correctness” of a recommendation. Nonetheless, application of the framework can facilitate the latter, because methodologists can most effectively and honestly critique recommendations whose rationale is transparent. We anticipate that this initial instantiation of the framework for making methods recommendations will evolve.”

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Findings and Lessons From the Improving Quality Through Clinician Use of Health IT Grant Initiative – AHRQ – released August 2013

Posted on August 19, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Findings and Lessons From the Improving Quality Through Clinician Use of Health IT Grant Initiative – AHRQ – released August 2013

“This report summarizes the extent to which the projects addressed the areas of interest of the IQHIT initiative and identifies practical insights regarding the use of health IT to improve clinical decisionmaking and care coordination in the ambulatory setting. It presents illustrative project findings in an effort to inform research discussion and provide guidance to other entities implementing health IT systems that help clinicians improve the quality of patient care. As the researchers continue to disseminate findings from these projects, additional lessons may become evident.”

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Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices – Agency for Healthcare Research and Quality, Rockville, MD – March 2013

Posted on March 13, 2013. Filed under: Patient Safety | Tags: , |

Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices – Agency for Healthcare Research and Quality, Rockville, MD – March 2013

This evidence report updates the 2001 report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices.

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Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – January 2013

Posted on March 11, 2013. Filed under: Research | Tags: , |

Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – January 2013

Edited by Priscilla Velentgas, PhD, Nancy A Dreyer, MPH, PhD, Parivash Nourjah, PhD, Scott R Smith, PhD, and Marion M Torchia, PhD.

Rockville (MD): Agency for Healthcare Research and Quality (US)
Publication No.: 12(13)-EHC099

“The Observational CER User’s Guide serves as a resource for investigators and stakeholders when designing observational comparative effectiveness research (CER) studies, particularly those with findings that are intended to translate into decisions or actions. The User’s Guide provides principles for designing research that will inform health care decisions of patients and other stakeholders. Furthermore, it serves as a reference for increasing the transparency of the methods used in a study and standardizing the review of protocols through checklists provided in every chapter.”

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Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – 12 February 2013

Posted on February 26, 2013. Filed under: Research | Tags: , , |

Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – 12 February 2013

“Researchers from the Effective Health Care Program’s DEcIDE Network authored this 11-chapter guide that aims to serve as a resource for researchers when developing observational comparative effectiveness research (CER) studies. The user’s guide identifies best practices for designing observational CER studies and standardizes the review of study protocols with checklists in each chapter. Topics in this user’s guide include developing study objectives and questions, study design, data sources, and analysis.

The educator resources, 12 presentations in PowerPoint format, are aligned with each chapter to expand training in these best practices.”

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Procalcitonin-Guided Antibiotic Therapy – AHRQ [US] – 5 October 2012

Posted on November 2, 2012. Filed under: Infectious Diseases, Pharmacy | Tags: , , |

Procalcitonin-Guided Antibiotic Therapy – AHRQ [US] – 5 October 2012

Full text

Soni NJ, Samson DJ, Galaydick JL, Vats V, Pitrak DL, Aronson N. Procalcitonin-Guided Antibiotic Therapy. Comparative Effectiveness Review No. 78. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 12(13)-EHC124-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2012.

“Structured Abstract

Objectives. To systematically review comparative studies of the use of procalcitonin in the clinical management of adult and pediatric patients with suspected local or systemic infection.

Data sources. MEDLINE®, Embase®, the Cochrane Database of Systematic Reviews, National Institute for Clinical Excellence, the National Guideline Clearinghouse, and the Health Technology Assessment Programme were searched from January 1, 1990, to December 16, 2011; the MEDLINE, Embase, and Cochrane searches were updated in December 2011. A search of the gray literature included databases with regulatory information, clinical trial registries, abstracts and conference papers, grants and federally funded research, and information from manufacturers.

Review methods. We sought studies that compared procalcitonin-guided versus clinical-criteria-guided initiation, discontinuation, or change of antibiotic therapy. Outcomes were antibiotic use, mortality, morbidity, and adverse drug events of antibiotic therapy. Data were abstracted by a single reviewer and fact-checked by a second reviewer. Study quality was assessed using the U.S. Preventive Services Task Force framework. A meta-analysis on short-term mortality in intensive care unit (ICU) patients was performed using a random-effects model. Strength of the body of evidence was assessed according to the AHRQ Methods Guide.

Results. There were 18 randomized, controlled trials that addressed five patient populations. Procalcitonin guidance reduces antibiotic use when used to discontinue antibiotics in adult ICU patients and to initiate or discontinue antibiotics in patients with respiratory tract infections (high evidence), without increasing morbidity (moderate evidence) and mortality (low evidence). In contrast, procalcitonin-guided intensification of antibiotics in adult ICU patients increases morbidity (moderate evidence). There is moderate evidence from a single good quality study that procalcitonin guidance reduces antibiotic use for suspected early neonatal sepsis, but insufficient evidence on morbidity and mortality outcomes was found. Evidence is insufficient to draw conclusions on outcomes of procalcitonin guidance for: (1) fever of unknown source in children 1–36 months of age; and (2) preemptive antibiotics after surgery.
Immunocompromised hosts and other special populations were generally excluded from procalcitonin guidance studies. Thus, findings from this review should not be extrapolated to patients with the following conditions: pregnancy; absolute neutropenia; immunocompromised states; chronic infections, and infections for which prolonged antibiotic therapy is standard of care (e.g., infective endocarditis).

Conclusions. Procalcitonin guidance reduces antibiotic use when used to discontinue antibiotics in adult ICU patients and to initiate or discontinue antibiotics in patients with respiratory tract infections. Populations for future research include immunocompromised patients, patients with other conditions (e.g., pregnancy, cystic fibrosis), and pediatric patients. Future research should compare procalcitonin guidance with antibiotic stewardship programs and to implementation of guidelines. Outcomes of high interest for future research are the consequences of reduction in antibiotic use for antibiotic resistance and for adverse events of antibiotic therapy.”

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Promoting Your Public Report: A Hands-on Guide – Agency for Healthcare Research and Quality [US] – February 2012

Posted on March 6, 2012. Filed under: Health Mgmt Policy Planning, Patient Participation | Tags: , |

Promoting Your Public Report: A Hands-on Guide – Agency for Healthcare Research and Quality [US] – February 2012

“This toolkit is designed to help communities increase awareness and use of their public reports by consumers and other important audiences. The suggested approaches and template materials are intended for use with the media, both in traditional settings (e.g., printed newspapers, radio broadcasts) and online avenues (e.g., news Web sites, blogs). The materials have been compiled for modification and use by Chartered Value Exchanges and others who produce public reports comparing health care quality, cost, patient experience, and other aspects of value.

Purpose

The suggested approaches and template materials in this toolkit are intended for use with the media, both in traditional settings (printed newspapers, broadcasts on radio and television) and online avenues (news Web sites, bloggers and podcasters, social media). The materials have been compiled for modification and use by Chartered Value Exchanges and others who produce public reports comparing health care quality, cost, patient experience, and other aspects of value. The intent is to help communities increase awareness and use of their public reports by consumers and other important audiences in each local community.”

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2010 National Healthcare Quality & Disparities Reports (US) – Agency for Healthcare Research & Quality – February 2011

Posted on March 1, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Health Status, Public Hlth & Hlth Promotion | Tags: , |

2010 National Healthcare Quality & Disparities Reports (US) – Agency for Healthcare Research & Quality – February 2011

“For the eighth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. New this year are chapters on care coordination, health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.

The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations. The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities.”

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Using Workforce Practices To Drive Quality Improvement: A Guide for Hospitals – Agency for Healthcare Research and Quality (US) – June 2010

Posted on January 14, 2011. Filed under: Workforce | Tags: |

Using Workforce Practices To Drive Quality Improvement:  A Guide for Hospitals – Agency for Healthcare Research and Quality (US) – June 2010

“The purpose of this guide is to provide hospital leaders and human resources staff a basic description of four high-performance work practices (HPWPs) that can help improve an organization’s capacity to effectively attract, select, hire, develop, and retain and deploy personnel in ways that best support a high-performing health care system. It also offers approaches and recommendations for implementing HPWPs in their organizations.”

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National Healthcare Quality Report – AHRQ – 2010

Posted on April 16, 2010. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

National Healthcare Quality Report 2009 – AHRQ – 2010
Full Report (PDF File, 4.4 MB)

The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations.

AHRQ Publication No. 10-0003
Current as of March 2010

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Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions – final research review – AHRQ US – 15 December 2009

Posted on December 22, 2009. Filed under: Diagnostics, Oncology | Tags: , , |

Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions – final research review – AHRQ (US) – 15 December 2009

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Non-surgical Method for Diagnosing Breast Cancer Safe, Nearly as Effective as Surgical Biopsy, New Report Finds
Press Release Date
: December 14, 2009

“Some methods of minimally invasive biopsy for breast cancer are nearly as accurate as surgical biopsy but have much less risk of harms, according to a new report funded by HHS’ Agency for Healthcare Research and Quality (AHRQ).

The report, prepared by the ECRI Institute’s Evidence-based Practice Center under contract to AHRQ’s Effective Health Care Program, compares traditional surgical biopsies with various types of “core needle biopsies,” which involve removing tissue through a special large hollow needle inserted through the skin.”

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