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CHALLENGES OF SUMMARIZING BETTER INFORMATION FOR BETTER HEALTH: THE EVIDENCE-BASED PRACTICE CENTER EXPERIENCE

Mark Helfand, MD, MPH; Sally Morton, PhD; Eliseo Guallar, MD, PhD; and Cynthia Mulrow, MD, MSc, Editors

Challenges in Using Nonrandomized Studies in Systematic Reviews of Treatment Interventions

Susan L. Norris, MD, MPH, and David Atkins, MD, MPH

21 June 2005 | Volume 142 Issue 12 Part 2 | Pages 1112-1119

Randomized, controlled trials (RCTs) are firmly established as the standard for determining which medical treatments are effective. In some areas of health care, however, among them surgery, public health, and the organization of health care delivery, most evidence addressing the effectiveness of clinical or policy interventions rests on nonrandomized studies. We examine the use of study designs other than RCTs in Evidence-based Practice Center reports addressing questions of the effectiveness of treatment interventions. These reports offer the opportunity to examine the approaches used and the challenges faced by reviewers when nonrandomized studies are included and their quality assessed. We then offer recommendations for using these studies in systematic reviews of treatment interventions.

Author and Article Information

From the Agency for Healthcare Research and Quality, Rockville, Maryland.

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

Requests for Single Reprints: Susan L. Norris, MD, MPH, Agency for Healthcare Research and Quality, Center for Outcomes and Evidence, Room 6325, 540 Gaither Road, Rockville, MD 20850; e-mail, snorris{at}ahrq.gov

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