Developing an evidence-based Guide to Community Preventive Services - Methods

Systematic reviews and evidence-based recommendations are increasingly impo rtant for decision making in health and medicine. Over the past 20 years, i nformation on the science of synthesizing research results has exploded. Ho wever, some approaches to systematic reviews of the effectiveness of clinic al preventive services and medical care may be less appropriate for evaluat ing population-based interventions Furthermore, methods for linking evidenc e to recommendations are less well developed than methods for synthesizing evidence. The Guide to Community Preventive Services: Systematic Reviews and Evidence -Based Recommendations (the Guide) will evaluate and make recommendations o n population-based and public health interventions. This paper provides an overview of the Guide's process to systematically review evidence and trans late that evidence into recommendations. The Guide reviews evidence on effectiveness, the applicability of effective ness data, (i.e., the extent to which available effectiveness data is thoug ht to apply to additional populations and settings), the intervention's oth er effects (i.e., important side effects), economic impact, and barriers to implementation of interventions. The steps for obtaining and evaluating evidence into recommendations involv e: (1) forming multidisciplinary chapter development teams, (2) developing a conceptual approach to organizing, grouping, selecting and evaluating the interventions in each chapter; (3) selecting interventions to be evaluated ; (4) searching for and retrieving evidence; (5) assessing the quality of a nd summarizing the body of evidence of effectiveness; (6) translating the b ody of evidence of effectiveness into recommendations; (7) considering info rmation on evidence other than effectiveness; and (8) identifying and summa rizing research gaps. Systematic reviews of and evidence-based recommendations for population-hea lth interventions are challenging and methods will continue to evolve. Howe ver, using an evidence-based approach to identify and recommend effective i nterventions directed at specific public health goals may reduce errors in how information is collected and interpreted, identify important gaps in cu rrent knowledge thus guiding further research, and enhance the Guide users' ability to assess whether recommendations are valid and prudent from their own perspectives. Over time, all of these advantages could help to increas e agreement regarding appropriate community health strategies and help to i ncrease their implementation. Medical Subject Headings (MeSH): community health services, decision making ; evidence based medicine; systematic reviews; methods; population-based in terventions; practice guidelines; preventive health services; public health practice; task force (C) 2000 American Journal of Preventive Medicine.