ALTERNATIVE METHODS FOR FORMAL LITERATURE-REVIEW AND METAANALYSIS IN AHCPR PATIENT OUTCOMES RESEARCH TEAMS

Formal literature review and synthesis is an important component of Pa tient Outcomes Research Teams (PORTs) and the development of clinical practice guidelines supported by the Agency for Health Care Policy and Research (AHCPR). Investigators face unresolved methodological issues and practical problems in carrying out this work because the use of s uch systematic reviews is relatively new in medicine. In addition, sta ndard metaanalytic methods may not readily be applied to the literatur e pertinent to most PORTs. Representatives of the InterPORT Work Group on Literature Review and Meta-Analysis exchanged information to ident ify and assess their respective approaches to these challenges. All 12 PORTs used systematic approaches to identifying relevant studies and to gather and analyze data abstracted from these studies. Most PORTs h ad undertaken or made plans for several separate reviews, which focuse d on a specific question about the outcomes of therapeutic health care services or procedures, diagnosis, prevention or prognosis. The descr iptive information provided by PORTs reveals substantial commonalities in their methods for searching literature and organizing bibliographi c databases. However, there was considerable variation in other aspect s of reviews, such as selection/exclusion criteria, the use of blindin g, and the techniques used to assess the quality of studies. Alternati ve approaches to literature review and synthesis warrant further exami nation because they have implications for research and health policy b oth in terms of the substantive conclusions and efficiency of reviews.