What we’re working on.. Defining the role of different types of evidence in decision-making. Develop tools to go from evidence to decisions about clinical care Develop tools to go from evidence to decisions about future research Standardize methods for comparative effectiveness research.

What we’re working on.. Defining the role of different types of evidence in decision-making. Develop tools to go from evidence to decisions about clinical care –Grading –Thresholds Develop tools to go from evidence to decisions about future research Standardize methods for comparative effectiveness research.

What we’re working on.. Defining the role of different types of evidence in decision-making. Develop tools to go from evidence to decisions about clinical care Develop tools to go from evidence to decisions about future research Standardize methods to minimize bias in comparative effectiveness research.

What we’re working on.. Defining the role of different types of evidence in decision-making. Develop tools to go from evidence to decisions about clinical care Develop tools to go from evidence to decisions about future research Standardize methods in comparative effectiveness research. –Topic development and refinement –Diagnostics

Why Worry about Methods? Transparency for the user Understanding variability in conclusions Reducing the risk of “mischief”

Approach to developing guidance When there is an evidence base, develop evidence-based standards When there isn’t, use structural approaches and support methodologic research

Improving topic selection and refinement Typical process Investigator chooses topic, target population, and outcomes AHRQ approach SRC and AHRQ develop questions Investigators are assigned a topic Investigator or a narrow spectrum of experts refine questions to ask in the review Patients, physicians, others help refine key questions Public comments on them

Geriatric patients with bedsores New enteral supplement Improved energy supply to, and microcirculation of, the wound Quality of life* Healing of bedsore * Mortality* diarrhea, Other Adverse effects EPCs use Analytic frameworks A new enteral supplement to heal bedsores. improved nutritional statuts

Issues in Diagnostic Test Evaluation 1.FRAMEWORKS: When are lower levels of evidence are adequate to assess a test? 2.Assessing applicability 3.Use of modeling 4.Assessing Harms of Diagnostic Tests 5.Other uses of tests –Prognosis –Selecting therapy

Hierarchy 1) the technical quality of test information; 2) diagnostic accuracy 3) change in the referring physician’s diagnostic thinking 4) change in the patient management Plan 5) change in patient outcomes; and 6) societal costs and benefits. Fryback and Thornbury