Academic journal article Research and Theory for Nursing Practice

Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence

Academic journal article Research and Theory for Nursing Practice

Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence

Article excerpt

The increased demand for evidence-based health care practices calls for comparative effectiveness research (CER), namely the generation and synthesis of research evidence to compare the benefits and harms of alternative methods of care. A significant contribution of CER is the systematic identification and synthesis of available research studies on a specific topic. The purpose of this article is to provide an overview of methodological issues pertaining to systematic reviews and meta-analyses to be used by investigators with the purpose of conducting CER. A systematic review or metaanalysis is guided by a research protocol, which includes (a) the research question, (b) inclusion and exclusion criteria with respect to the target population and studies, (c) guidelines for obtaining relevant studies, (d) methods for data extraction and coding, (e) methods for data synthesis, and (f ) guidelines for reporting results and assessing for bias. This article presents an algorithm for generating evidence-based knowledge by systematically identifying, retrieving, and synthesizing large bodies of research studies. Recommendations for evaluating the strength of evidence, interpreting findings, and discussing clinical applicability are offered.

Keywords: evidence-based practice; research

The demand for health care practices that are evidence-based, standardized, consistent, and promote optimal outcomes within the constraints of limited resources is growing. Today's health care technologies provide a wide range of interventions, tests, and strategies for prevention, risk management, and treatment of many diseases. Staying current with new evidence can be overwhelming for providers. Patient advocates suggest that patients become informed consumers within the health care system and actively choose a course of action that is in line with their own values. However, the information necessary to inform health care decisions is often incomplete or unavailable. As a result, many of the interventions and treatments used today are delivered without clear evidence of their effectiveness.

The Institute of Medicine (IOM) has called for a national research initiative to support better decision making in health care (Sox & Greenfield, 2009). This research, known as comparative effectiveness research (CER), aims to identify what practices work, for which patients, and under what circumstances. CER is defined as ". . . the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care" (IOM, 2009, p. 2). This definition emphasizes the need for direct comparisons of effective interventions to identify the care, which is most appropriate for individual patients and families. CER answers two distinct questions: (a) "Is Intervention A better than Intervention B for an individual patient?" and (b) "What are the clinical characteristics of patients who are more likely to benefit from a specific intervention?" The answers to these questions can help consumers, health care providers, purchasers, and policy makers make informed decisions that will improve health care at both the individual and population level.

Realizing the full potential of CER depends on accessing, evaluating, and synthesizing large bodies of heterogeneous studies (Sox et al., 2010). Systematic reviews and meta-analyses are based on scientific strategies that reduce bias to assemble, appraise, and synthesize relevant studies on a specific topic. Meta-analysis is a subsequent step of a systematic review that can be applied when appropriate; it is a statistical technique that pools data from many individual studies and provides a combined estimate of efficacy of a particular treatment from the overall evaluation of these studies (Lipsey & Wilson, 2001).

The purpose of this article is to provide an algorithm for the conduct of systematic reviews and meta-analyses. …

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