Article type
Year
Abstract
Background: Policymakers face choices about how much evidence and certainty about that evidence is needed to support decisions that must be made within the constraints of limited budgets and timelines. Methodologic rigor and time are generally considered to be trade-offs, where one or the other is sacrificed to achieve policymakers' goals.
Objectives:
1. To describe the evolution of rapid evidence review methods used to inform health coverage decisions in one US state;
2. To discuss the applicability of rapid review methods to support health policy decisions.
Methods: Key informant interviews and process mapping.
Results: The state has developed 50 coverage determinations since 2010. Rapid evidence reviews to support these decisions have evolved, undergoing three distinct phases. The initial phase (2010-2012) used the ADAPTE framework to produce clinical practice guidelines. Three adapted guidelines were produced and timelines ranged from 13 to 23 months per guideline. During the second phase (2012-2014) 33 coverage 'guidances' were produced using a set of core systematic review source documents only. Process mapping found that the time from topic announcement to approval averaged 44 weeks which was 18 weeks over projected. Common sources of delay were related to additional research requests and evidence identified during public comment. Methods evolved to address concerns about quality and timeliness of evidence reviews during third phase (2014-present). Current rapid review methods involve expanded scope definition work, comprehensive searching for systematic reviews and additional studies, and addition of GRADE tables. Fourteen topics have used these revised rapid review methods with improvements in both timeliness and quality.
Conclusions: Increasing rigor of rapid review methods has been necessary to support timely coverage decisions in one US state. Investing more time in the evidence review phase has saved time in the public comment and decision process such that both timeliness and quality have improved. Finding the right balance required some trial and error, and involved consultation with stakeholders and ongoing evaluation efforts.
Objectives:
1. To describe the evolution of rapid evidence review methods used to inform health coverage decisions in one US state;
2. To discuss the applicability of rapid review methods to support health policy decisions.
Methods: Key informant interviews and process mapping.
Results: The state has developed 50 coverage determinations since 2010. Rapid evidence reviews to support these decisions have evolved, undergoing three distinct phases. The initial phase (2010-2012) used the ADAPTE framework to produce clinical practice guidelines. Three adapted guidelines were produced and timelines ranged from 13 to 23 months per guideline. During the second phase (2012-2014) 33 coverage 'guidances' were produced using a set of core systematic review source documents only. Process mapping found that the time from topic announcement to approval averaged 44 weeks which was 18 weeks over projected. Common sources of delay were related to additional research requests and evidence identified during public comment. Methods evolved to address concerns about quality and timeliness of evidence reviews during third phase (2014-present). Current rapid review methods involve expanded scope definition work, comprehensive searching for systematic reviews and additional studies, and addition of GRADE tables. Fourteen topics have used these revised rapid review methods with improvements in both timeliness and quality.
Conclusions: Increasing rigor of rapid review methods has been necessary to support timely coverage decisions in one US state. Investing more time in the evidence review phase has saved time in the public comment and decision process such that both timeliness and quality have improved. Finding the right balance required some trial and error, and involved consultation with stakeholders and ongoing evaluation efforts.