New Chapters Added to Systematic Review Methods Guide

The original Methods Guide for Comparative Effectiveness Reviews was created through a collaborative effort between the Agency for Healthcare Research and Quality (AHRQ), the Scientific Resource Center, and the Evidence-based Practice Centers (EPCs) and posted on the AHRQ Web site in late 2007. The Effective Health Care Program intended that the guide would serve as a resource for EPCs, as well as for other investigators interested in conducting Comparative Effectiveness Reviews.

An updated version has been in progress since 2008. Four chapters of the revised guide have already been published, with versions of the chapters appearing in the Journal of Clinical Epidemiology:

• Forward: Comparing Medical Interventions: AHRQ and the Effective Health Care Program. AHRQ Manuscript: Published 18 Nov 2008. Other publication(s): Slutsky J, Atkins D, Chang S, et al. Comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2008 Sep 30.)
• Principles in Developing and Applying Guidance for Comparing Medical Interventions. AHRQ Manuscript: Published 08 Aug 2009. Other publications(s): Helfand M, Balshem H. Principles for developing guidance: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2009 May 6.
• Assessing Harms when Comparing Medical Interventions. AHRQ Manuscript: Published 18 Nov 2008. Other publication(s): Chou R, Aronson N, Atkins D, et al. Assessing harms when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2008 Sep 25.
• Identifying, Selecting and Refining Topics for Comparative Effectiveness Systematic Reviews. AHRQ Manuscript: Published 27 Apr 2009. Other publications(s): Whitlock E, Lopez S, Chang S, et al. Identifying, selecting, and refining topics for comparative effectiveness systematic reviews: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2009 June 21.
• Grading the Strength of a Body of Evidence when Comparing Medical Interventions. AHRQ Manuscript: Published 05 Aug 2009. Other publication(s): Owens D, Lohr K, Atkins D, et al. Grading the strength of a body of evidence when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2009 Jul 11.

Two more chapters will be published shortly:

Using Existing Systematic Reviews to Replace de Novo Processes in CERs. AHRQ Manuscript: Draft posted for public comment 26 May 2009.

Updating Comparative Effectiveness Reviews. AHRQ Manuscript: Draft posted for public comment 22 September 2009.

Each chapter within the Methods Guide is drafted by a workgroup made up of Evidence-based Practice Center (EPC) investigators, AHRQ staff and Scientific Resource Center staff. This guide describes recommended approaches for addressing difficult, frequently encountered methodological issues when preparing a systematic review.

New draft guidance for conducting systematic reviews on medical tests will soon be available. EPC investigators are developing the guidance documents, which are scheduled to come out in draft form in the fall of 2009.

With the rapid advances in medicine, there are an ever-increasing number of choices for medical testing, although evidence regarding the benefits and risks may be scant or lacking. Because it is uncommon for randomly controlled trials to be conducted for medical testing, the systematic effectiveness review of medical testing can be challenging. To address many of the difficult and significant variations in the reporting of medical testing, the authors of this chapter of the Methods Guide present a structural outline for the evaluation process. The series consists of three sections covering the evaluation of clinical tests -- from considering the context, conducting the review, and synthesizing the evidence -- with extra material on the historical context. There also are special issues related to the evaluation of genetic testing and prognostic tests.