U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Cover of EPC Methods: An Exploration of Methods and Context for the Production of Rapid Reviews

EPC Methods: An Exploration of Methods and Context for the Production of Rapid Reviews

Research White Papers

Investigators: , BScPT, MSc, PhD, , MD, MPH, , MD, MRP, , MPH, , PhD, , PhD, MPH, , PhD, , PhD, , MLIS, , BA-Hon, MA, , PhD, , BS, , MS, , MLIS, , PhD, , MD, SM, FACP, , MD, MSCE, and , MD, MPH.

Author Information and Affiliations
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 15-EHC008-EF

Structured Abstract

Objectives:

To characterize rapid reviews and similar products, to understand the context in which rapid products are produced (e.g., end-users and purposes for rapid products), to understand methodological guidance and strategies used to make products rapid and describe how these differ from systematic review (SR) procedures, and to identify empiric evidence on the impact of methodological approaches on their reliability and validity.

Methods:

We searched the literature to identify rapid review methods, empiric evidence on rapid review methodology, and methodological guidance. We conducted interviews with members of organizations known to produce rapid reviews to characterize the types of rapid products produced and to understand the context and uses for rapid products, identify current practices, and understand the evolution of their programs and products.

Results:

We identified 36 examples of rapid products produced by 20 organizations with production time ranging from 5 minutes to 8 months.

We categorized rapid products into four groups based on the extent of synthesis: (1) ”inventories” list what evidence is available, and other contextual information needed to make decisions, but do not synthesize the evidence or present summaries or conclusions; (2) ”rapid responses” present the end-user with an answer based on the best available evidence (usually guidelines or SRs), but do not attempt to formally synthesize the evidence into conclusions; (3) ”rapid reviews” perform a synthesis (qualitative and/or quantitative) to provide an answer about the direction of evidence and possibly the strength of evidence; (4) “automated approaches” use databases of extracted study elements and programming to generate meta-analyses in response to user-defined queries.

Methodological approaches identified for rapid products include: searching fewer databases; limited use of grey literature; restricting the types of studies included (e.g., English only, most recent 5 years); relying on existing SRs; limiting full-text review; limiting dual review for study selection and/or data extraction; limiting data extraction; limiting risk of bias assessment or grading; minimal evidence synthesis; providing nominal conclusions or recommendations; and limiting external peer review. As the timeframes for products lengthened many limitations were lifted; however, there were still restrictions on database searching, inclusion, extent of data extraction, and dual review. With lengthened production time, there was more often risk of bias assessment, evidence grading, and external peer review.

Key informant interviews demonstrated that the essence of rapid products differs from that of SRs: key differences include the close relationship with the end-user and focus on helping a specific end-user make a specific decision in an identified timeframe. Because there may not be lead time before the review is needed and the end-user may need the review urgently, maintaining a highly skilled staff is critical to organizational readiness to produce rapid reviews. Having few and/or narrow questions (e.g., emerging technologies, single interventions, specific populations) was also necessary.

There is almost no empiric evidence directly comparing results of rapid products with SRs. One report suggested there may not be any impact; however, it focused on surgical interventions and may not be generalizable to other clinical specialties or health care fields in which rapid products or SRs are conducted.

Conclusions:

Rapid products have tremendous methodological variation. Overall, they vary on two important dimensions that are captured by the term “rapid review”: the timeframe for completion and extent of synthesis. The similarity of rapid products lies in their close relationship with the end-user to meet decisionmaking needs in a limited timeframe. The following are considerations for creating rapid products:

  • products should be developed in the context of identified end-users and their specific decisionmaking needs and circumstances;
  • a close relationship with the end-user and iterative feedback is essential;
  • reliance on existing SRs require methods to summarize and interpret evidence;
  • a highly skilled and experienced staff and the capacity to mobilize skilled staff quickly are critical;
  • restricting scope may be necessary;
  • producers and users need to accept modifications to standard SR methods; and
  • limitations need to be clearly reported, particularly in terms of potential bias and shortcomings of the conclusions.

Future research evaluating end-user perspectives will complement these findings and provide additional considerations for those interested in establishing a rapid response program or producing rapid products.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, . Contract No. 290-2012-00004-C. Prepared by: Scientific Resource Center, Portland, OR

This research was funded through contracts from the Agency for Healthcare Research and Quality to the following Evidence-based Practice Centers: University of Alberta (290-2012-00013-I), Blue Cross Blue Shield (290-2012-00010-I), ECRI- Penn (290-2012-00011-I), Kaiser (290-2012-00015-I), The Johns Hopkins University (290-2012-00007-I), and the Scientific Resource Center for the EPC Program (290-2012-00004-C).

Suggested citation:

Hartling L, Guise J-M, Kato E, Anderson J, Aronson N, Belinson S, Berliner E, Dryden D, Featherstone R, Foisy M, Mitchell M, Motu'apuaka M, Noorani H, Paynter R, Robinson KA, Schoelles K, Umscheid CA, Whitlock E. EPC Methods: An Exploration of Methods and Context for the Production of Rapid Reviews. Research White Paper. (Prepared by the Scientific Resource Center under Contract No. 290-2012-00004-C.) AHRQ Publication No. 15-EHC008-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Centers' Methods Workgroup 4 (Contract No. 290-2012-00004-C). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policy makers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www‚Äč.ahrq.gov

Bookshelf ID: NBK274092PMID: 25654160

Views

Related information

Similar articles in PubMed

See reviews...See all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...