1. AHRQ annual meeting September 10, 2008 Stephanie Chang MD, MPH Center for Outcomes and Evidence Conducting a methodologically sound systematic review with limited resources: An introduction

2. Objectives Understand breadth of methods issues in conducting systematic reviews Understand breadth of methods issues in conducting systematic reviews Identify available resources for methods guidance Identify available resources for methods guidance Identify available resources for conducting a review Identify available resources for conducting a review

3. Conducting systematic reviews

4. Elements of systematic review Clarify critical questions Clarify critical questions Specify appropriate sources of information to address questions Specify appropriate sources of information to address questions Evaluate quality of individual studies Evaluate quality of individual studies – Internal and external validity Summarize evidence for each question Summarize evidence for each question – Qualitative synthesis, Meta-analysis – (Decision analysis, Cost-effectiveness)

5. Methodology of systematic reviews Relevant, but independent Relevant, but independent – Engaging partners for Key Questions – Engage partners for translation – Technical expert panel Comprehensive, rigorous, unbiased Comprehensive, rigorous, unbiased – Complete literature review – Assessment of study quality – A priori definitions – Peer review Transparent Transparent – Reporting of methods used – Methods Guide

6. AHRQ Evidence-based Practice Centers BC/BS TEC BC/BS TEC U. Conn U. Conn Duke U. Duke U. ECRI ECRI Johns Hopkins U. Johns Hopkins U. McMaster U. McMaster U. U. Minnesota U. Minnesota Oregon HSU Oregon HSU U. So California. - RAND U. So California. - RAND RTI – UNC RTI – UNC Tufts Tufts UCSF - Stanford U. UCSF - Stanford U. U. Alberta U. Alberta U. Ottawa U. Ottawa Evidence-based Practice Centers conduct systematic reviews

7. Methods Guide Resources Methods Guide for Conducting Comparative Effectiveness Reviews – Topic Development – Selecting Evidence – Finding Evidence – Assessing Quality of individual studies – Assessing Applicability – Assessing Harms – Quantitative Synthesis – Rating a body of evidence www.effectivehealthcare.ahrq.gov/www.effectivehealthcare.ahrq.gov/www.effectivehealthcare.ahrq.gov/ http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethod sGuide.pdfhttp://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethod sGuide.pdfhttp://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethod sGuide.pdfhttp://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethod sGuide.pdf Cochrane Handbook and Glossary – http://www.cochrane.org/resources/handbook/ http://www.cochrane.org/resources/handbook/

8. Software tools Data Management Data Management Evidence Tables Evidence Tables Meta-analysis Meta-analysis RevMan RevMan – http://www.cc-ims.net/RevMan http://www.cc-ims.net/RevMan GradePro GradePro – http://www.cc-ims.net/gradepro http://www.cc-ims.net/gradepro Comprehensive Meta-analysis ($) Comprehensive Meta-analysis ($) – http://www.meta-analysis.com/ http://www.meta-analysis.com/ Statistical software Statistical software – STATA, SAS, SPSS ($) TrialStat! ($) TrialStat! ($) – http://www.trialstat.com/ http://www.trialstat.com/

9. Questions? Stephanie Chang Stephanie.chang@ahrq.hhs.gov Stephanie.chang@ahrq.hhs.gov