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Finding What Works in Health Care: Standards for Systematic Reviews (2011)

Chapter: Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review

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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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D
Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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TABLE D-1 Comparison of Chapter 2 Guidance on Conducting Systematic Reviews (SRs) of Comparative Effectiveness Research

Standards and Elements

Agency for Healthcare Research and Quality  (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

2.1 Establish a team with appropriate expertise and experience to conduct the systematic review

Provides guidance on establishing a review team (see below).

Provides guidance on establishing a review team (see below).

Provides guidance on establishing a review team (see below).

2.1.1 Include expertise in pertinent clinical content areas

Must include an individual with relevant clinical expertise, and when indicated, access to specialists with relevant expertise.

Ideally includes an individual with knowledge of the relevant clinical/topic area.

Must include expertise in the topic area being reviewed.

2.1.2 Include expertise in systematic review methods

Must include an individual with expertise in conducting SRs.

Ideally includes an individual with expertise in SR methods, and/or qualitative research methods where appropriate.

Must include, or have access to, expertise in SR methodology.

2.1.3 Include expertise in searching for relevant evidence

Must include an individual with library expertise.

Ideally includes an individual with information retrieval skills.

Either a Trials Search Coordinator does the search, or a Trials Search Coordinator or librarian should be consulted.

2.1.4 Include expertise in quantitative methods

Must include an individual with statistical expertise.

Ideally includes an individual with expertise in statistics and health economics.

Must include, or have access to, statistical expertise.

2.1.5 Include other expertise as appropriate

Not mentioned.

Includes a range of skills.

Review authors are encouraged to seek and incorporate the views of users and stakeholders.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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2.2 Manage bias and conflict of interest (COI) of the team conducting the systematic review

Provides guidance on managing bias and COI in the review team (see below).

Provides guidance on managing bias and COI in the review team (see below).

Provides guidance on managing bias and COI in the review team (see below).

2.2.1 Require each team member to disclose potential COI and professional or intellectual bias

Must disclose relevant financial, business, and professional interests.

COI should be noted early in the process and steps taken to ensure that these do not impact the review.

Financial COI should be avoided, but must be disclosed if there is any. Also, any secondary interests that might unduly influence judgments made in a review should be disclosed. All authors must sign declarations of interest.

2.2.2 Exclude individuals with a clear financial conflict

Evidence-based Practice Center (EPC) core team and any authors on the reports are barred from having any significant competing interests.

Recommends that all biases are declared. Does not specifically address the issue of whether it is appropriate to include individuals with vested financial interests in the review team.

Reviews should be free of real or perceived bias or COI. Reviews cannot be sponsored by commercial sources.

2.2.3 Exclude individuals whose professional or intellectual bias would diminish the credibility of the review in the eyes of the intended users

EPC core team and any authors on the reports are barred from having any significant competing interests.

Any COI, including professional or intellectual bias, should be declared.

Personal conflicts must be disclosed.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

Standards and Elements

Agency for Healthcare Research and Quality  (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

2.3 Ensure user and stakeholder input as the review is designed and conducted

Engage a range of stakeholders across various sectors in the United States. Categories include clinicians; consumer/patients (including representative organizations); employers and business groups; federal and state partners; healthcare industry representatives; payers; health plans and policy makers; and researchers.

There may be a number of individuals or groups who are consulted at various stages, including healthcare professionals, patient representatives, service users, and experts in research methods. Some funding bodies may require the establishment of an advisory group who will comment on the protocol and final report and provide input to ensure that the review has practical relevance to likely end-users.

It may be useful to form an advisory group of people, including representation of relevant stakeholders, to ensure that authors address the questions of importance to stakeholders.

2.3.1 Protect the independence of the review team to make the final decisions about the design, analysis, and reporting of the review

The name of the EPC conducting an SR is not provided to the public until the draft report the to protect authors from external influence. Key informant and technical experts have no role in writing, analyzing, or drafting paper. Peer reviewers are selected to have no significant COI.

Not mentioned.

Sponsorship by any commercial sources with financial interests in the conclusions of Cochrane reviews is prohibited. The sponsor should not be allowed to delay or prevent publication of a review, or interfere with the independence of the authors of reviews.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

2.4 Manage bias and COI for individuals providing input into the systematic review

Provides guidance on managing bias and COI for individuals providing input into the SR (see below).

Not mentioned.

Not mentioned.

2.4.1 Require individuals to disclose potential COI and professional or intellectual bias

Participants, consultant, subcontracts, and other technical experts must disclose in writing any financial, business, and professional interests that are related to the subject matter of a review.

The next edition of the guidance will make explicit that all biases must be declared early in process and steps taken to ensure that these do not impact on the review.

Not mentioned.

2.4.2 Exclude input from individuals whose COI or bias would diminish the credibility of the review in the eyes of the intended user

Advisors or experts are not automatically excluded if there are conflicts, particularly for topic development and refinement. When an individual has a potential conflict and is providing input as part of a group, the conflicts must be disclosed and balanced. Experts may be excluded for conflicts depending on the stage of the review and how input is provided.

The next edition of the guidance will note that professional and intellectual bias must be declared, but should not preclude being part of an advisory group.

Not mentioned.

2.5 Formulate the topic for the systematic review

Provides guidance on topic formulation (see below).

Provides guidance on topic formulation (see below).

Provides guidance on topic formulation (see below).

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

Standards and Elements

Agency for Healthcare Research and Quality  (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

2.5.1 Confirm the need for a new review

AHRQ has specific criteria to ensure the need for a new review. Topics should have strong potential for significantly improving health outcomes or for reducing unnecessary care or cost and also concern important decisions for consumers or for one or more of these groups: patients, clinicians, health system leaders, purchasers, payers, and policy makers. Should consider the available research basis for a topic and if current, high-quality research is available or underway. Try to reduce duplication of existing reviews.

Must check if there is an existing or ongoing review on topic to see if new review justified. Search Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, and others. If there is an existing review, assess for quality (using CRD critical appraisal). If high quality, see if update is justified. If completed some time ago, an update may be justified.

Many Cochrane Review Groups have developed priorities for reviews of importance. Topics suggested by review authors must be approved by the appropriate Cochrane Review Group. The background section of the protocol should clearly state the rationale for the review and should explain why the questions being asked are important. It might also mention why this review was undertaken and how it might relate to a wider review of a general problem.

2.5.2 Develop an analytic framework that clearly lays out the chain of logic that links the health intervention to the outcomes of interest and defines the key clinical questions to be addressed by the systematic review

Develop an analytic framework that portrays relevant clinical concepts and the clinical logic underlying beliefs about the mechanism by which interventions may improve health outcomes.

Communicate key contextual factors and conceptual issues relevant to review question. Explain why review is required and rationale for focus of the review.

Not mentioned.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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2.5.3 Use a standard format to articulate each clinical question of interest

Topics selected for comparative effectiveness SRs are focused into research questions using the PICOTS mnemonic: population, intervention, comparator, outcome, timing, and setting.

The protocol should include the review questions framed using PICOS: population, intervention, comparator, outcome, and setting. The review question may be presented in general terms, or, more often the actual question is discussed by the review team and an objective, or series of objectives, framed by the PICOS format is agreed.

The protocol should include a well-formulated question. Questions are stated broadly as review “objectives” and specified in detail as “criteria for considering studies for this review.” The clinical question should address all of the elements in PICO: population, intervention, comparator, and outcome.

2.5.4 State the rationale for each clinical question

Fully explain the rationale for formulating each clinical question.

State the objectives for undertaking the review.

The background section of the protocol should clearly state the rationale for the review and should explain why the questions being asked are important. Each review group has a title registration process. Some of their forms require statement of motivation for doing the review.

2.5.5 Refine each question based on user and stakeholder input

Topic refinement requires input from stakeholders (key informants) that represent the broad-based constituencies of the EHC (Effective Health Care Program) and for the particular topic area.

Engaging stakeholders who are likely to be involved in implementing the recommendations of the review helps to ensure that the review is relevant to their needs. The form of involvement depends on the project. Where reviews have strict time constraints, consultation may be impossible.

If present, an advisory group may be involved in making and refining decisions about the interventions of interest, the populations to be included, priorities for outcomes, and possibly subgroup analyses.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

Standards and Elements

Agency for Healthcare Research and Quality  (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

2.6 Develop a systematic review protocol

Requires a protocol (see below).

Requires a protocol (see below).

Requires a protocol (see below).

2.6.1 Describe the context and rationale for the review from both a decision-making and research perspective

Fully explain the rationale for formulating each clinical question.

Explain why the review is required and provide a rationale for the inclusion criteria and focus of the review.

The background section should address the context for the review question based on an already-formed body of knowledge, the rationale for the review, and why the questions being asked are important.

2.6.2 Describe the study screening and selection criteria (inclusion/exclusion criteria)

Protocol should include detailed explanation and justification for inclusion/exclusion criteria.

Inclusion criteria should be set out in the protocol. Specify the process by which decision on the selection of studies will be made, including the number of researchers who will screen titles and abstracts and then full papers, and the method for resolving disagreements about study eligibility.

Include the criteria for selecting studies for the review, including the types of studies, types of participants, types of interventions, and types of outcome measures.

2.6.3 Describe precisely which outcome measures, time points, interventions, and comparison groups will be addressed

Define the outcome measures.

Specify the comparators and interventions that are eligible for the review, the defined set of relevant outcomes, and the timing of outcome assessment.

Review authors should consider how outcomes may be measured, both in terms of the type of scale likely to be used and the timing of measurement.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Specify the interventions of interest and the interventions against which these will be compared. When specifying drug interventions, factors such as the drug preparation, route of administration, dose, duration, and frequency should be considered.

2.6.4 Describe the search strategy for identifying relevant evidence

Describe the search strategy (including databases and search terms) in the protocol.

Include the preliminary search strategy for identifying relevant results. This should specify the databases and additional sources that will be searched, and also the likely search terms to be used.

Search methods must be described. Inclusion of the search strategy is optional.

2.6.5 Describe the procedures for study selection

Provide plans to assess evidence against inclusion/exclusion criteria.

Inclusion criteria should be set out in the protocol. Specify the process by which decision on the selection of studies will be made, including the number of researchers who will screen titles and abstracts and then full papers, and the method for resolving disagreements about study eligibility.

Include the methods used to apply the selection criteria.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

Standards and Elements

Agency for Healthcare Research and Quality  (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

2.6.6 Describe the data extraction strategy

Describe how the data are extracted from each study and methods for collecting and managing the information. Identify key characteristics that might be necessary for evidence synthesis due to their role in effect modification of the intervention–treatment association and thus limit the applicability of findings.

Include the data extraction strategy. The data collected will depend on the type of question being addressed, and the types of study available. Describe the data to be extracted and provide details on the software used for recording data. Specify if authors of primary studies will be contacted to provide missing or additional data. If using foreign language papers, may need to specify translation arrangements.

Include the methods used to extract or obtain data from published reports or from original researchers.

2.6.7 Describe the process for identifying and resolving disagreement between researchers in study selection and data extraction decisions

Describe how discrepancies among researchers will be resolved in the protocol.

Describe how discrepancies between researchers will be resolved.

Include a process for identifying and resolving disagreement between researchers in study selection, data extraction, and assessment of risk of bias in included studies.

2.6.8 Describe the approach to critically appraising individual studies

Describe the approach for assessing study quality in the protocol.

Specify the method of study appraisal, including the details of how the study appraisal is to be used (e.g., will inform sensitivity analyses). Also specify the process for conducting the appraisal, the number of researchers involved, and how disagreements will be resolved.

Include the method used to assess risk of bias in individual studies.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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2.6.9 Describe the method for evaluating the body of evidence, including the quantitative and qualitative synthesis strategies

Discuss how evidence will be summarized in a clinically relevant manner either as a narrative or using meta-analysis. Clearly state plans for meta-analysis and predefine clinical groups that are too heterogeneous to allow for meta-analysis or clinical groups for which the qualitative analysis will be presented separately. Identify, a priori, subgroups that will be explored to explain potential heterogeneity.

Specify the data synthesis strategy. State how heterogeneity will be explored and quantified, under what circumstances a meta-analysis would be considered appropriate, and whether a fixed or random-effects model or both would be used. Describe any planned subgroup or sensitivity analyses or investigation of publication bias.

Address whether a meta-analysis is intended, whether to prespecify an effect measure, how to handle heterogeneity, whether to assume a fixed-effect or random-effects model, how to incorporate risk of bias, how to handle missing data, how to address reporting biases.

A qualitative synthesis strategy is not required.

The approach to narrative synthesis should be outlined. Should specify the outcomes of interest and what effect measures will be used.

Describe how the report will present findings, including the ordering of outcomes or other categorization scheme.   Describe methods for prioritizing or selecting the most important outcomes to be presented in tables or summary key results (i.e., did key informants or the Technical Expert Panel help inform prioritization of outcomes?).

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

Standards and Elements

Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

 

Describe how criteria will be used to determine overall strength of the body of evidence for each key question and which outcomes will be graded.

2.6.10 Describe and justify any planned analyses of differential treatment effects according to patient subgroups, how an intervention is delivered, or how an outcome is measured

Clearly state plans for meta-analysis and predefine clinical groups that are too heterogeneous to allow for meta-analysis or clinical groups for which the qualitative analysis will be presented separately. Identify, a priori, subgroups that will be explored to explain potential heterogeneity.

Any planned subgroup analyses should also be described in the data synthesis section.

Authors should, whenever possible, prespecify characteristics in the protocol that later will be subject to subgroup analyses or meta-regression.

2.6.11 Describe the proposed timetable for conducting the review

EPCs are to include time line in their workplan to AHRQ. AHRQ posts approximate final completion date.

Not mentioned.

Protocols include a date when the review is expected. Reviews must be completed within 2 years, or they may be withdrawn from the Cochrane Database of Systematic Reviews.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

2.7 Submit the protocol for peer review

Not mentioned.

Some commissioning or funding bodies may require that they formally approve the protocol, and will provide input to the draft protocol. In addition, other stakeholders, such as clinical and methodological experts, patient groups, and service users, may be consulted in approving the protocol.

Protocols should go out for external peer review.

2.7.1 Provide a public comment period for the protocol and publicly report on disposition of comments

Public comment period is provided for key questions, but not protocol. Protocol is posted publicly, but not available for peer or public comment. The protocol is developed with input by and reviewed by a Technical Expert Panel.

Advocate where evidence base is contested: create dedicated, publicly accessible websites that provide information about all aspects of the review. These websites enable external scrutiny of the review process, and include feedback facilities for interested parties to comment, ask questions, or submit evidence for consideration.

Approved protocols are automatically published on the Cochrane Database of Systematic Reviews. The Cochrane Library Feedback tool allows users to provide comments on and feedback of Cochrane reviews and protocols in The Cochrane Library. If accepted, the feedback will be published.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×

Standards and Elements

Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program

Centre for Reviews and Dissemination (CRD)

The Cochrane  Collaboration

2.8 Make the final protocol publicly available, and add any amendments to the protocol in a timely fashion

Key questions are available for public review and comment prior to start of review. Protocol is made publicly available, but not for comment after start of a review. Modifications to protocol should be clearly documented and justified, then posted and available to the public.

Not mentioned. The next edition will recommend making the protocol publicly available. Modifications to the protocol should be clearly documented and justified.

Approved protocols are automatically published on the Cochrane Database of Systematic Reviews. Any changes to the protocol must be documented and reported in the completed review.

NOTE: Some information on methods recommended by AHRQ, CRD, and Cochrane was provided via personal communication with Stephanie Chang, EPC Program Task Order Officer, AHRQ (October 5, 2010); Lesley Stewart, Director, CRD (October 14, 2010); and Julian Higgins, Senior Statistician, MRC Biostatistics Unit, Institute of Public Health, University of Cambridge (October 4, 2010).

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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REFERENCES

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Chou, R., N. Aronson, D. Atkins, A. S. Ismaila, P. Santaguida, D. H. Smith, E. Whitlock, T. J. Wilt, and D. Moher. 2010. AHRQ series paper 4: Assessing harms when comparing medical interventions: AHRQ and the Effective Health Care Program. Journal of Clinical Epidemiology 63(5):502–512.

CRD (Centre for Reviews and Dissemination). 2009. Systematic reviews: CRD’s guidance for undertaking reviews in health care. York, UK: York Publishing Services, Ltd.

Fu, R., G. Gartlehner, M. Grant, T. Shamliyan, A. Sedrakyan, T. J. Wilt, L. Griffith, M. Oremus, P. Raina, A. Ismaila, P. Santaguida, J. Lau, and T. A. Trikalinos. 2010. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. In Methods guide for comparative effectiveness reviews, edited by Agency for Healthcare Research and Quality. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayProduct&productID=554 (accessed January 19, 2011).

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Norris, S., D. Atkins, W. Bruening, S. Fox, E. Johnson, R. Kane, S. C. Morton, M. Oremus, M. Ospina, G. Randhawa, K. Schoelles, P. Shekelle, and M. Viswanathan. 2010. Selecting observational studies for comparing medical interventions. In Methods guide for comparative effectiveness reviews, edited by Agency for Healthcare Research and Quality. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayProduct&productID=454 (accessed January 19, 2011).

Owens, D. K., K. N. Lohr, D. Atkins, J. R. Treadwell, J. T. Reston, E. B. Bass, S. Chang, and M. Helfand. 2010. AHRQ series paper 5: Grading the strength of a body of evidence when comparing medical interventions: AHRQ and the Effective Health Care Program. Journal of Clinical Epidemiology 63(5):513–523.

Relevo, R., and H. Balshem. 2011. Finding evidence for comparing medical interventions. In Methods guide for comparative effectiveness reviews, edited by Agency for Healthcare Research and Quality. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayProduct&productID=605 (accessed January 19, 2011).

Slutsky, J., D. Atkins, S. Chang, and B. A. Collins Sharp. 2010. AHRQ series paper 1: Comparing medical interventions: AHRQ and the Effective Health Care Program. Journal of Clinical Epidemiology 63(5):481–483.

White, C. M., S. Ip, M. McPheeters, T. S. Carey, R. Chou, K. N. Lohr, K. Robinson, K. McDonald, and E. Whitlock. 2009. Using existing systematic reviews to replace de novo processes in CERs. In Methods guide for comparative effectiveness reviews, edited by Agency for Healthcare Research and Quality. http://www.effective-healthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayProduct&productID=329 (accessed January 19, 2011).

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Whitlock, E. P., S. A. Lopez, S. Chang, M. Helfand, M. Eder, and N. Floyd. 2010. AHRQ series paper 3: Identifying, selecting, and refining topics for comparative effectiveness systematic reviews: AHRQ and the Effective Health Care Program. Journal of Clinical Epidemiology 63(5):491–501.

Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
×
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Suggested Citation:"Appendix D: Expert Guidance for Chapter 2: Standards for Initiating a Systematic Review." Institute of Medicine. 2011. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. doi: 10.17226/13059.
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Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines.

Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process.

In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain.

Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

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