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

  1. Dena M. Bravata, MD, MS;
  2. Kathryn M. McDonald, MM;
  3. Kaveh G. Shojania, MD;
  4. Vandana Sundaram, MPH; and
  5. Douglas K. Owens, MD, MS
  1. 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.
    1. Figure 1. This figure describes 3 stages of evidence synthesis used in a systematic review evaluating reports of information technologies and decision support systems for bioterrorism preparedness and response. The description of the full conceptual framework and results of this systematic review are available elsewhere. Figure modified with permission from reference : Bravata DM, McDonald KM, Szeto H, Smith WM, Rydzak C, Owens DK. Med Decis Making, pp. 192-206, copyright 2004 by Society for Medical Decision Making. Reprinted by permission of Sage Publications.
      View larger version:
        Figure 1. This figure describes 3 stages of evidence synthesis used in a systematic review evaluating reports of information technologies and decision support systems for bioterrorism preparedness and response. The description of the full conceptual framework and results of this systematic review are available elsewhere. Figure modified with permission from reference : Bravata DM, McDonald KM, Szeto H, Smith WM, Rydzak C, Owens DK. Med Decis Making, pp. 192-206, copyright 2004 by Society for Medical Decision Making. Reprinted by permission of Sage Publications. Approach to problem formulation, data collection, and analysis and interpretation of reports of information technologies and decision support systems for bioterrorism preparedness and response.(24)(14)24
      • Figure 2. This figure uses influence diagram notation to depict the key decisions of clinicians and public health officials responding to bioterrorism (rectangular decision nodes), to identify the uncertain events affecting these decisions (elliptic chance nodes), and to evaluate the information that is observable by the decision makers at the time they make their decisions. The schematic depicts 3 critical time periods as follows: Time period 1 refers to the interval in which decisions are made by clinicians regarding the events associated with the initial cases; time period 2 refers to the interval in which decisions are made by public health officials regarding the events associated with the initial cases; and time period 3 refers to the interval in which decisions are made by clinicians regarding the events associated with the subsequent cases. The decisions and processes depicted in this figure could be supported by information technologies and decision support systems designed to facilitate bioterrorism preparedness and response. Figure reprinted with permission from reference : Bravata DM, McDonald KM, Szeto H, Smith WM, Rydzak C, Owens DK. Med Decis Making, pp. 192-206, copyright 2004 by Society for Medical Decision Making. Reprinted by permission of Sage Publications.
        View larger version:
          Figure 2. This figure uses influence diagram notation to depict the key decisions of clinicians and public health officials responding to bioterrorism (rectangular decision nodes), to identify the uncertain events affecting these decisions (elliptic chance nodes), and to evaluate the information that is observable by the decision makers at the time they make their decisions. The schematic depicts 3 critical time periods as follows: Time period 1 refers to the interval in which decisions are made by clinicians regarding the events associated with the initial cases; time period 2 refers to the interval in which decisions are made by public health officials regarding the events associated with the initial cases; and time period 3 refers to the interval in which decisions are made by clinicians regarding the events associated with the subsequent cases. The decisions and processes depicted in this figure could be supported by information technologies and decision support systems designed to facilitate bioterrorism preparedness and response. Figure reprinted with permission from reference : Bravata DM, McDonald KM, Szeto H, Smith WM, Rydzak C, Owens DK. Med Decis Making, pp. 192-206, copyright 2004 by Society for Medical Decision Making. Reprinted by permission of Sage Publications. Schematic of decisions made by clinicians and public health officials during a bioterrorism response.24
        • Figure 3. . An analytic framework with the linkages between antecedent factors (generally not modifiable), work environment conditions (which can either impede or improve work quality, and are therefore denoted as “demands” or “resources”), and the resultant influence on patient safety and outcomes. . Conceptual model of patient safety derived from several sources. The research team used these representations to develop a series of research questions focusing on the effects of the 5 categories of working conditions on patient outcomes related to patient safety, rate of medical error, rate of error recognition, and probability of adverse events. For example, one key question of this review was the following: Does the complexity of the plan of care influence whether working conditions affect patient outcomes that are related to patient safety? An asterisk denotes where this key question fits in the conceptual framework.
          View larger version:
            Figure 3. . An analytic framework with the linkages between antecedent factors (generally not modifiable), work environment conditions (which can either impede or improve work quality, and are therefore denoted as “demands” or “resources”), and the resultant influence on patient safety and outcomes. . Conceptual model of patient safety derived from several sources. The research team used these representations to develop a series of research questions focusing on the effects of the 5 categories of working conditions on patient outcomes related to patient safety, rate of medical error, rate of error recognition, and probability of adverse events. For example, one key question of this review was the following: Does the complexity of the plan of care influence whether working conditions affect patient outcomes that are related to patient safety? An asterisk denotes where this key question fits in the conceptual framework. Analytic framework and conceptual model of patient safety from the evidence report “The Effect of Health Care Working Conditions on Patient Safety.”TopBottom
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          1. Ann Intern Med June 21, 2005 vol. 142 no. 12 Part 2 1056-1065
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