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Abstract
Background: The Agency for Healthcare Research and Quality (AHRQ), under the aegis of the United States Department of Health and Human Services, supports the conduct of systematic reviews (SRs) on a wide array of clinical topics. With a rapidly changing healthcare environment, AHRQ’s efforts to conduct SRs of complex interventions are taking on increasing importance. AHRQ is supporting a meeting of experts in complex interventions to identify practical tools and guidance for scoping reviews, creating appropriate analytic frameworks, and analyzing data (June 2015, Washington DC).
Objectives: To create practical tools for and guidance on conducting systematic reviews of complex interventions.
Methods: Guidance will be issued around best practice and applications of new methodological approaches for analysis of complex interventions, based on a group consensus process of international experts in evidence reviews, research, and healthcare implementation of complex interventions.
Results: SRs of complex interventions can vary widely in purpose, data availability and heterogeneity, and end-user expectations. Questions from end-users may range from exploratory to confirmatory. Underlying sources of complexity can arise from context, intervention, implementation, and participant responses. The analytic framework chosen to answer systematic review questions will need to account for end-user needs, sources of complexity, and causal or associative links. Analytic approaches can vary in data requirements or underlying causal assumptions. We summarize the guidance developed through multiple workgroups. Specifically, we touch upon context, frameworks, and tools for complex intervention; address the range of questions posed in SRs; and the analytic approaches available to answer these questions. We offer a decision framework to select the analytic approach best suited to the context of the systematic review and note data requirements, expertise needed, statistical power, and computing resources.
Conclusions: The resulting guidance will aid a global audience of systematic reviewers of complex interventions in improving the utility and rigor of their reviews.
Objectives: To create practical tools for and guidance on conducting systematic reviews of complex interventions.
Methods: Guidance will be issued around best practice and applications of new methodological approaches for analysis of complex interventions, based on a group consensus process of international experts in evidence reviews, research, and healthcare implementation of complex interventions.
Results: SRs of complex interventions can vary widely in purpose, data availability and heterogeneity, and end-user expectations. Questions from end-users may range from exploratory to confirmatory. Underlying sources of complexity can arise from context, intervention, implementation, and participant responses. The analytic framework chosen to answer systematic review questions will need to account for end-user needs, sources of complexity, and causal or associative links. Analytic approaches can vary in data requirements or underlying causal assumptions. We summarize the guidance developed through multiple workgroups. Specifically, we touch upon context, frameworks, and tools for complex intervention; address the range of questions posed in SRs; and the analytic approaches available to answer these questions. We offer a decision framework to select the analytic approach best suited to the context of the systematic review and note data requirements, expertise needed, statistical power, and computing resources.
Conclusions: The resulting guidance will aid a global audience of systematic reviewers of complex interventions in improving the utility and rigor of their reviews.