1 / 31

Presentation of Findings

Presentation of Findings. Prepared for: The Agency for Healthcare Research and Quality (AHRQ) Training Modules for Systematic Reviews Methods Guide www.ahrq.gov. Systematic Review Process Overview. Learning Objectives.

jtruong
Download Presentation

Presentation of Findings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Presentation of Findings Prepared for: The Agency for Healthcare Research and Quality (AHRQ) Training Modules for Systematic Reviews Methods Guide www.ahrq.gov

  2. Systematic Review Process Overview

  3. Learning Objectives • To understand the goals of presenting systematic review data in tables that summarize data across studies • To become familiar with approaches to graphical presentations of findings not synthesized through statistical or meta-analytic techniques

  4. Organizing and Reporting Findings • Once the evidence tables are completed, there is an enormous (sometimes overwhelming) amount of data yet to synthesize. • Various types of heterogeneity may preclude a quantitative synthesis (e.g., meta-analysis). • Synthesizing heterogeneous studies by using tables (nonquantitative synthesis) can capture underlying similarities to support conclusions. • Making sense of the data requires good tabular presentation, in addition to clear organization and writing of the text.

  5. Why Not Meta-analysis? • Even studies meeting the same inclusion criteria can vary. • Clinical heterogeneity — variation in the study population, interventions, and outcomes • Methodological heterogeneity — variation in study design • Statistical heterogeneity — variation in observed treatment effect (for trials) • Many factors can contribute to variation in seemingly similar studies. • Some examples are evolving diagnostic criteria, evolving diseases, differences in baseline characteristics, and differences in care. • Not all studies can (or should) be combined statistically. • Various statistical models are useful for identifying the level of heterogeneity between studies. AHRQ . Methods reference guide for effectiveness and comparative effectiveness reviews. Version 1.0. Available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf.

  6. Solution • Nonquantitative synthesis using tables that summarize data across studies • Use of evidence maps to provide an overview of the data

  7. PICOTS • Population: primary populations of interest are followed by subpopulations • Intervention: hierarchy of interventions may reflect most common to least common • Comparator: where multiple comparisons are made, one might present the more “usual” decision first • Outcome: a hierarchy of outcomes may reflect higher to lower acuity or target outcomes followed by collateral ones; harms are generally presented last • Timing: short term generally precedes long term • Setting: an intervention may be available in various settings (e.g., inpatient or outpatient)

  8. Combining Studies • Evidence tables are the first step to summarization, but each evidence table represents the data in only one study. • Incorporating multiple studies into a single table allows entire subsets of the literature to be summarized and compared (e.g., by key question or study design). • Summary tables and evidence maps are two approaches with which information about individual studies and results are combined. • Authors should use caution when deciding which evidence to summarize so as not to introduce a biased perspective.

  9. Summary Tables (I) • Combine data from multiple studies to illustrate trends in the data • May be focused on describing study characteristics, results, or both • Can be designed to include characteristics of all included studies • Examples: funding sources, assessment method, country of study • Can be designed for subsets of included studies • Examples: summary tables for randomized controlled trials, prevalence studies, harms/side effects, outcomes for specific treatments

  10. Summary Tables (II) • Simplified entry (one row) for each study • Table columns may include, for example: • PICOTS (may be listed in table title or headers) • Methodological quality • Applicability • Study size (weight) • Magnitude of effect • A single study may be represented in multiple summary tables (e.g., different outcomes) PICOTS = population, intervention, comparator, outcomes, timing, and setting

  11. Example:Summary Table of Study Characteristics • A basic summary table is the “study characteristics” table. • The overall summary provides an overview of the state of the available studies in the literature. Hartmann KE, et al. AHRQ Evidence Report/Technology Assessment No. 187. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/ bladder/bladder.pdf.

  12. Example: Summary Table as High-Level Map Chung M, et al. AHRQ Evidence Report/Technology Assessment No. 183. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/vitadcal/vitadcal.pdf.

  13. Example: Summary Table of Study Characteristics Balk EM, et al. Ann Intern Med 2003;139:670-82. Reprinted with permission from the American College of Physicians.

  14. Visual Presentation of Available Comparisons Ip S, et al. AHRQ Evidence Report/Technology Assessment No. 124. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/rhinoupdate/rhinoup.pdf.

  15. Example:Summary Table of Prevalence Findings Summary tables can be specialized for different types of questions. Hartmann KE, et al. AHRQ Evidence Report/Technology Assessment No. 187. Available at: http://www.ahrq.gov/ downloads/pub/evidence/ pdf/ bladder/bladder.pdf.

  16. Example:Summary Table for Randomized Controlled Trials Summary tables can be specialized for different subgroups of the literature. Hartmann KE, et al. AHRQ Evidence Report/Technology Assessment No. 187. Available at: http://www.ahrq.gov/ downloads/pub/evidence/pdf/bladder/bladder.pdf.

  17. Example: Summary Table for Cohort Studies Wang C, et al. AHRQ Evidence Report/Technology Assessment No. 94. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/o3cardio/o3cardio.pdf.

  18. Example: Presentation of Harms Data Summary tables can be specialized for different subgroups of the literature. Hartmann KE, et al. AHRQ Evidence Report/Technology Assessment No. 187. Available at: http://www.ahrq.gov/ downloads/pub/evidence/ pdf/ bladder/bladder.pdf.

  19. Example:Presentation of Data by Outcome and Age Chung M, et al. AHRQ Evidence Report/Technology Assessment No. 183. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/vitadcal/vitadcal.pdf.

  20. Example:Presentation of Patient-Reported Outcomes Summary tables can be specialized for different types of outcomes. Hartmann KE, et al. AHRQ Evidence Report/Technology Assessment No. 187. Available at: http://www.ahrq.gov/ downloads/pub/evidence/ pdf/ bladder/bladder.pdf.

  21. Evidence Maps • Are a succinct graphical presentation of available studies to address key questions along variables of interest • Results of outcomes typically not included • Can help to identify comparisons with sufficient evidence for analysis • Can help to guide readers in knowing what comparisons and outcomes are available in the report • Can help to identify evidence gaps

  22. Example: Evidence Map Terasawa T, et al. Ann Intern Med 2009;151:556-65. Reprinted with permission from the American College of Physicians.

  23. A Second Approach to an Evidence Map Dt: time (to stable dose) INR: international normalized ratio mean dose: mean maintenance dose Raman G, et al. AHRQ Technology Assessment No. GEND1206. Available at: http://www.cms.gov/determinationprocess/downloads/id61TA.pdf.

  24. Forest Plot Without Summary Favors Wide-Area Circumferential Ablation Favors Pulmonary Vein Isolation Ip S, et al. AHRQ Comparative Effectiveness Review No. 15. Available at: http://www.effectivehealthcare.ahrq.gov/ehc/products/51/114/2009_0623RadiofrequencyFinal.pdf.

  25. Summary Matrix Wang C, et al. AHRQ Evidence Report/Technology Assessment No. 94. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/o3cardio/o3cardio.pdf.

  26. Key Messages • Summary tables and evidence maps provide key information on study characteristics and study findings. Through table and graphical formats, respectively • Properly constructed summary tables: • Effectively convey results • Provide an overview of the literature in a given field • Enable the reader to grasp results for subsets of the literature

  27. References (I) • Agency for Healthcare Research and Quality. Methods reference guide for effectiveness and comparative effectiveness reviews. Version 1.0. Rockville, MD: Agency for Healthcare Research and Quality, Draft Posted October 2007. Chapter 2, Finding evidence. Available at: http://effectivehealthcare.ahrq.gov/repFiles/ 2007_10DraftMethodsGuide.pdf. • Balk EM, Lau J, Goudas LC, et al. Effects of statins on nonlipid serum markers associated with cardiovascular disease. Ann Intern Med 2003;139:670-82. • Chung M, Balk EM, Brendel M, et al. Vitamin D and Calcium: A Systematic Review of Health Outcomes. Evidence Report/Technology Assessment No. 183. (Prepared by Tufts–New England Medical Center Evidence-based Practice Center under Contract No. HHSA 290-2007-10055-I). Rockville, MD: Agency for Healthcare Research and Quality, August 2009. AHRQ Publication No. 09-E015. Available at: http://www.ahrq.gov/downloads/pub/ evidence/pdf/vitadcal/vitadcal.pdf.

  28. References (II) • Hartmann KE, McPheeters ML, Biller DH, et al. Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment No. 187 (Prepared by Vanderbilt University Evidence-based Practice Center under Contract No. 290-2007-10065-I). Rockville, MD: Agency for Healthcare Research and Quality, August 2009. AHRQ Publication No. 09-E017. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/bladder/ bladder.pdf. • Ip S, Fu L, Balk E, et al. Update on Acute Bacterial Rhinosinusitis. Evidence Report/Technology Assessment No. 124. (Prepared by Tufts–New England Medical Center Evidence-based Practice Center under Contract No. 290-02-0022). Rockville, MD: Agency for Healthcare Research and Quality, June 2005. AHRQ Publication No. 05-E020-2. Available at: http://www.ahrq.gov/downloads/pub/ evidence/pdf/rhinoupdate/rhinoup.pdf .

  29. References (III) • Ip S, Terasawa T, Balk EM, et al. Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation. Comparative Effectiveness Review No. 15 (Prepared by Tufts–New England Medical Center Evidence-based Practice Center under Contract No. 290-02-0022). Rockville, MD: Agency for Healthcare Research and Quality, July 2009. AHRQ Pub. No. 09-EHC015-EF. Available at: http://www.effectivehealthcare.ahrq.gov/ ehc/products/51/114/2009_0623RadiofrequencyFinal.pdf. • Raman G, Trikalinos TA, Zintzaras E, et al. Reviews of Selected Pharmacogenetic Tests for Non-Cancer and Cancer Conditions. Technology Assessment No. GEND1206 (Prepared by Tufts–New England Medical Center Evidence-based Practice Center under Contract No. 290-02-0022). Rockville, MD: Agency for Healthcare Research and Quality, November 2008. Available at: http://www.cms.gov/determinationprocess/downloads/id61TA.pdf.

  30. References (IV) • Terasawa T, Dvorak T, Ip S, et al. Systematic review: charged-particle radiation therapy for cancer. Ann Intern Med 2009;151:556-65. • Wang C, Chung M, Balk E, et al. Effects of Omega-3 Fatty Acids on Cardiovascular Disease. Evidence Report/Technology Assessment No. 94 (Prepared by Tufts–New England Medical Center Evidence-based Practice Center under Contract No. 209-02-0022). Rockville, MD: Agency for Healthcare Research and Quality, March 2004. AHRQ Publication No. 04-E009-2. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/o3cardio/o3cardio.pdf.

  31. Authors • This presentation was prepared by Melissa L. McPheeters, Ph.D., M.P.H., and Jeff Seroogy, B.S., members of the Vanderbilt University Evidence-based Practice Center, and Joseph Lau, M.D., and Thomas Trikalinos, M.D., Ph.D., members of the Tufts Medical Center Evidence-based Practice Center. • The information in this module is currently not included in Version 1.0 of the Methods Guide for Comparative Effectiveness Reviews (available at: http://www.effectivehealthcare.ahrq.gov/ehc/ products/60/294/2009_0805_principles1.pdf).

More Related