Challenges in Systematic Reviews: Synthesis of Topics Related to the Delivery, Organization, and Financing of Health Care

21 June 2005 | Volume 142 Issue 12 Part 2 | Pages 1056-1065

Some important health policy topics, such as those related to the delivery, organization, and financing of health care, present substantial challenges to established methods for evidence synthesis. For example, such reviews may ask: What is the effect of for-profit versus not-for-profit delivery of care on patient outcomes? Or, which strategies are the most effective for promoting preventive care? This paper desc ribes innovative methods for synthesizing evidence related to the delivery, organization, and financing of health care. We found 13 systematic reviews on these topics that described novel methodologic approaches. Several of these syntheses used 3 approaches: conceptual frameworks to inform problem formulation, systematic searches that included nontraditional literature sources, and hybrid synthesis methods that included simulations to address key gaps in the literature. As the primary literature on these topics expands, so will opportunities to develop additional novel methods for performing high-quality comprehensive syntheses.

Author and Article Information

From Stanford University–University of California, San Francisco, Evidence-based Practice Center and the Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California; University of Ottawa, Ottawa Health Research Institute, Ottawa, Canada; and Veterans Affairs Palo Alto Health Care System, Palo Alto, California.

Acknowledgments: The authors thank Jody L. Mechanic, RN, MS, for her assistance in preparing this manuscript.

Grant Support: This work was performed by the Stanford–University of California, San Francisco, Evidence-based Practice Center under contract number 290-02-0017 to the Agency for Healthcare Research and Quality, Rockville, Maryland. Dr. Owens was supported by the Department of Veterans Affairs.

Potential Financial Conflicts of Interest: Authors of this paper have received funding for Evidence-based Practice Center reports.

Requests for Single Reprints: Dena M. Bravata, MD, MS, Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019; e-mail, dbravata{at}stanford.edu.

Current Author Addresses: Drs. Bravata, McDonald, and Sundaram: Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019.

Dr. Shojania: Ottawa Health Research Institute; The Ottawa Hospital–Civic Campus, 1053 Carling Avenue, Room C403, Box 693, Ottawa K1Y 4E9, Ontario.

Dr. Owens: Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019.