Finding What Works in Health Care: Standards for Systematic Reviews by Institute of Medicine of the National Academies

Author:Institute of Medicine of the National Academies
Language: eng
Format: epub
Tags: Health and Medicine : Policy, Reviews and Evaluations. Health and Medicine : Healthcare and Quality
ISBN: 0309216710
Publisher: NATIONAL ACADEMIES PRESS
Published: 2011-06-20T00:00:00+00:00

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Standards for Synthesizing the Body of Evidence

Abstract: This chapter addresses the qualitative and quantitative synthesis (meta-analysis) of the body of evidence. The committee recommends four related standards. The systematic review (SR) should use prespecified methods; include a qualitative synthesis based on essential characteristics of study quality (risk of bias, consistency, precision, directness, reporting bias, and for observational studies, dose–response association, plausible confounding that would change an observed effect, and strength of association); and make an explicit judgment of whether a meta-analysis is appropriate. If conducting meta-analyses, expert methodologists should develop, execute, and peer review the meta-analyses. The meta-analyses should address heterogeneity among study effects, accompany all estimates with measures of statistical uncertainty, and assess the sensitivity of conclusions to changes in the protocol, assumptions, and study selection (sensitivity analysis). An SR that uses rigorous and transparent methods will enable patients, clinicians, and other decision makers to discern what is known and not known about an intervention’s effectiveness and how the evidence applies to particular population groups and clinical situations.

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