Article type
Year
Abstract
Background: randomized controlled trials (RCTs) are the most robust form of primary evidence to use when determining the effectiveness of an intervention. However, conducting RCTs may not always be possible due to ethical or implementation issues, resulting in the use of other study designs. Systematic reviews that exclude high-quality, non-randomized studies risk excluding relevant evidence.
Objectives: to describe and reflect on the methods used and challenges encountered in a complex systematic review addressing the effectiveness and cost-effectiveness of organizational interventions to reduce length of stay of older adults admitted to hospital for planned procedures.
Methods: 218 articles were eligible for inclusion, evaluating a variety of interventions across a range of surgical specialties. Following team discussion, incorporating views of clinical stakeholders, we prioritized 73 studies for further synthesis: RCTs, representing the most robust evidence from high-income countries and UK-based controlled trials or uncontrolled before and after studies, representing the most relevant evidence for commissioners of research and health services in the UK. We needed to organize evidence from the two overlapping sets of studies in a way that met the needs of our different intended audiences. Monthly meetings provided the opportunity to reflect on strategies to combine these highly heterogeneous sets of studies into a meaningful synthesis.
Results: we summarized both sets of studies using narrative summary tables accompanied by a text overview, with detailed descriptions of results provided in an appendix. We combined and synthesized RCTs using meta-analysis where appropriate, with UK literature analyzed separately from studies conducted in other healthcare systems. We used narrative synthesis to bring together the UK evidence.
To facilitate the synthesis process and ensure that the results were accessible and meaningful to our audience, we also grouped the studies according to the type of intervention being evaluated within surgical procedure groups. Stakeholder advice was sought to ensure that these groupings accurately reflected clinical practice.
Conclusions: synthesizing evidence from RCTs separately from studies conducted within the UK meant we could focus on both the best quality and most relevant evidence to the UK health system. The two syntheses allowed our audience to consider their own requirements with respect to reducing the risk of bias versus the relevance of the research to the UK setting. Inclusion of RCTs conducted outside of the UK provides the opportunity to incorporate this knowledge into UK clinical practice and further research.
Patient or healthcare consumer involvement: we sought input from older adults with experience of planned hospital admission throughout this review, informing our screening process, interpretation of results and identification of the outcomes most important to patients.
Objectives: to describe and reflect on the methods used and challenges encountered in a complex systematic review addressing the effectiveness and cost-effectiveness of organizational interventions to reduce length of stay of older adults admitted to hospital for planned procedures.
Methods: 218 articles were eligible for inclusion, evaluating a variety of interventions across a range of surgical specialties. Following team discussion, incorporating views of clinical stakeholders, we prioritized 73 studies for further synthesis: RCTs, representing the most robust evidence from high-income countries and UK-based controlled trials or uncontrolled before and after studies, representing the most relevant evidence for commissioners of research and health services in the UK. We needed to organize evidence from the two overlapping sets of studies in a way that met the needs of our different intended audiences. Monthly meetings provided the opportunity to reflect on strategies to combine these highly heterogeneous sets of studies into a meaningful synthesis.
Results: we summarized both sets of studies using narrative summary tables accompanied by a text overview, with detailed descriptions of results provided in an appendix. We combined and synthesized RCTs using meta-analysis where appropriate, with UK literature analyzed separately from studies conducted in other healthcare systems. We used narrative synthesis to bring together the UK evidence.
To facilitate the synthesis process and ensure that the results were accessible and meaningful to our audience, we also grouped the studies according to the type of intervention being evaluated within surgical procedure groups. Stakeholder advice was sought to ensure that these groupings accurately reflected clinical practice.
Conclusions: synthesizing evidence from RCTs separately from studies conducted within the UK meant we could focus on both the best quality and most relevant evidence to the UK health system. The two syntheses allowed our audience to consider their own requirements with respect to reducing the risk of bias versus the relevance of the research to the UK setting. Inclusion of RCTs conducted outside of the UK provides the opportunity to incorporate this knowledge into UK clinical practice and further research.
Patient or healthcare consumer involvement: we sought input from older adults with experience of planned hospital admission throughout this review, informing our screening process, interpretation of results and identification of the outcomes most important to patients.
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