Exhibit 1Examples of advocacy/policy positions

Example 1, Personal Position

A national health system is advocating the implementation of the primary care medical home model. AHRQ commissions an SR about the effectiveness of this model. The SR team seeks a senior administrator from the health system who has a background in health services research and who has been charged with regional implementation of the medical home program to serve as a team member. As a team member, she urges a broad definition of primary care practice organization and management, and inclusion of studies aimed at specific components of practice change, with the net effect of including a large number of favorable studies of marginal applicability. Hence, the resulting report seems to be more supportive of these sorts of interventions, albeit with a lower strength of evidence than might have been found using a narrower view of the intervention.

Example 2, Affiliated Organization Position

A State neurology society has a position statement saying that medications for restless leg syndrome are ineffective and have no place in therapy. Dr. Archibald is the president-elect for the society but not an author of their position paper. He is asked to be an SR team member on a project looking into the comparative effectiveness of medications for restless leg syndrome versus supportive care alone. Dr. Archibald does not hold a strong personal opinion about the benefits and risks of medications for restless leg syndrome, but he is conflicted. Becoming president is the culmination of several years of hard work. He would feel uncomfortable if the results of the report were contrary to the organization’s position paper. Given his knowledge of the literature, he knows that studies looking at one symptom scoring scale show medications to be effective while studies using another scale do not show evidence of effectiveness, but both scales are valid and commonly used, but have different strengths and weaknesses. He persuades the SR team (given his neurology experience and stature in the neurology community) to use one scale exclusively. The report subsequently finds no benefits are derived from the use of medications for restless leg syndrome.

From: Identifying, Measuring, and Managing NFCOI

Cover of Identifying and Managing Nonfinancial Conflicts of Interest for Systematic Reviews
Identifying and Managing Nonfinancial Conflicts of Interest for Systematic Reviews [Internet].
Viswanathan M, Carey TS, Belinson SE, et al.

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