Methods

Investing in the science of research synthesis will increase the quality and the value of the evidence provided in systematic reviews. As a new field, attention to the methods used to conduct systematic reviews and attention to improving the existing methods are critically important. About two decades of research underpins the methods that are being used to search, identify, appraise, and interpret the evidence presented in a systematic review (Egger et al., 2001; Mulrow and Lohr, 2001). Much remains to be learned, and numerous unresolved methodological issues remain (Helfand, 2005; Neumann, 2006). Research is needed on methods for identifying observational studies, using observational evidence in the absence of randomized data, and better understanding the impact of potential biases (Egger et al., 2003; Gluud, 2006; Hopewell et al., 2007a,b; Kunz et al., 2007; Song et al., 2000). Box 4-5 lists some of the most pressing methodological issues.

Recommendation: The Program should assess the capacity of the research workforce to meet the Program’s needs, and, if deemed appropriate, it should expand training opportunities in systematic review and comparative effectiveness research methods.

Research Workforce

It is not known how many researchers in the United States are adequately trained and qualified to conduct systematic reviews on the effectiveness of health care services. At present, AHRQ provides predoctoral and postdoctoral educational and career development grants in health services research (Medicare Payment Advisory Commission, 2007). The agency also provides institution-level grants to support the planning and development of health services research in certain types of institutions. The NIH also supports a wide range of research training opportunities. However, it is not known to what extent the AHRQ and NIH training programs focus on systematic reviews.

Thus, it is unknown but likely that the nation has insufficient human capacity to support an expanded national effort to generate systematic reviews of clinical effectiveness. The Program should assess the research workforce to see if it is adequate. If necessary, the Program should provide more opportunities for training in the conduct of systematic reviews and comparative effectiveness research. A field can grow and produce high-quality work only if it attracts and retains creative investigators. There must be opportunities to learn and grow professionally. To be attractive to the best and the brightest individuals, the field must adhere to high standards of research quality and scientific integrity, be open to new ideas and people,



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