Datasets:

marianna13
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litarch

+{"file": "methrespoc_NBK206754/appa.nxml", "text": "Comparative Effectiveness Reviews selected for utilization monitoring", "pairs": [], "interleaved": []}
+{"file": "methrespoc_NBK206754/discussion.nxml", "text": "We identified citations in one or more clinical POC tools for slightly more than half of the CERs we analyzed. Journal articles were used slightly more frequently that reports. Use of the CERs may be influenced by several factors, including POC evidence summary update timing, topic, POC tool, and accessibility of CER publication(s). UpToDate included more AHRQ CER product citations than DynaMed or First Consult. Evidence summaries in FirstConsult often lacked recent updates, making citation impossible. Citation of the CERs was typically to acknowledge reviews that had been conducted on the topic and not to make specific clinical points.\nWe hope to expand upon this pilot project and continue to collect and analyze data to identify patterns of use. Because use appears to be topic dependent, it was difficult with a small sample size to attempt to generate hypotheses about topic classification (general or specific, condition-focused vs. intervention focused, primary care vs. subspecialist, prevalence of condition, etc.), publication number and types, or publication timing on rate of use. Our results appeared to be a function of the convenience sample of reports we selected and our somewhat subjective selection criteria for what constituted a matching POC product. This could distort the findings, so our ability to analyze use patterns was limited. Additionally, simple numerical reporting and accounting may not be sufficient to fully understand use. Some CER topics better matched POC evidence summary topics, this is another pattern that could be explored in future research. We will gain more information to enhance the ability to identify trends as we expand data collection and analysis. We also expect that other factors we did not address might influence CER use. These include factors describing the topic nomination (guideline group vs. community member) or the degree of buy-in from experts in the field for CER topics (which could somehow be measured using a Technical Expert Panel and/or peer review recruitment information or acceptance of the findings based upon the peer reviews), the number of existing systematic reviews on the topic, etc. A more in-depth analysis specific to each POC tool might present useful information that could potentially influence uptake.\nNext Steps\nThis pilot project was conducted to provide quick information about the use of AHRQ EPC reports in clinician POC tools to determine whether more scientific and ongoing monitoring of these increasingly important clinician resources would be worthwhile. The information provided is interesting and valuable. However given the necessity of a quick turn-around, the methodology has significant limitations preventing more useful analysis and interpretation. We plan to enhance this pilot investigation to provide more in-depth, accurate, and meaningful analysis that will lead to generalizable conclusions. We specifically plan to address:\nSelection of POC tools/enhanced background information. We selected those available at the University of Minnesota. More in-depth investigation to the background, methodology, and aims of widely available POC tools would allow a more informed, contextualized, scientific (potentially), and appropriate-to-topic selection of tools. Additionally, an improved understanding of how the evidence summaries are created and updated within studied tools would provide valuable contextual information that may help to explain CER use.\nMatching of CERs and POC tools. Our pilot project selected a convenience sample of CERs and investigated their use in the most closely matched product within each POC tool. In some cases, the POC product did not exactly match the CER topic and this may have affected the rate of use. A larger sample may provide categorization of topics to calculate rates of use using more appropriate denominators. Another would be to identify as set of POC products for which a closely matched EPC CER was available and relevant to that evidence summary to assess use. This will be explored in future efforts.\nCommunication with POC tool vendors. Our pilot project did not attempt to collect information from the creators or vendors of the POC tools. Our next phase of this project will begin with a more in-depth understanding of the POC tools and how they are used. We will also explore contacting the vendors of these tools for information or commentary considered important to understanding their use of our products.\nConclusion\nThis pilot project represents an important first step in documenting use of EPC CERs in the increasingly popular clinical POC tools. We found evidence of moderate use of EPC CERs in three common POC products. Further research is necessary to identify patterns in these rates of use. POC tools are expected to become increasingly important resources for clinicians. Improved understanding of their use of EPC CERs could assist AHRQ in dissemination planning.", "pairs": [], "interleaved": []}
+{"file": "methrespoc_NBK206754/appb.nxml", "text": "Review of point-of-care tool evidence summaries for EPC CER citations", "pairs": [], "interleaved": []}
+{"file": "methrespoc_NBK206754/methods.nxml", "text": "We selected a convenience sample of AHRQ EPC CER reports for which to track citations in POC tools. First, we included all CERs that were examined in the 2012 Web utilization project (n=13).4 We included these reports to compare use across resource type in a subsequent stage of this project. We next established criteria to select a second group of reports. Selection criteria were 1) report date between 2008 and 2012, 2) clinical topic commonly diagnosed and initially treated or referred from primary care. These report date criteria allowed time since the CER availability for the POC products to find the new information and update relevant evidence summaries. We narrowed the list of topics to those addressed in primary care because this audience appears to be the target of many clinical POC tools. We first applied these criteria to all Minnesota EPC reports that had not already been selected (n=3 met criteria). We focused on our EPC's reports because we were knowledgeable about these reports, had a database listing all associated journal articles, and had a vested interest in evaluating their utilization. We then applied the criteria to the population of CER reports conducted across all EPCs and selected those meeting the criteria (n=7) that were not already selected in a previous step. If two versions of a CER on the same topic appeared, we selected the most recent version. We arrived at a total sample of 23 reports.\nOnce we established the list of CERs, we compiled a list of published articles that emerged from those reviews. We used several methods to identify journal articles related to AHRQ reports. We conducted forward citation searching in Google Scholar to identify journal articles that cited the full report and searched for author names and titles consistent with the report. We also conducted MEDLINE searches for topic, dates, and author names consistent with the report.\nUsing this sample of reports and related articles, we conducted topic searches in three POC tools available through the University of Minnesota Libraries (DynaMed, UpToDate, and First Consult). We used search terms for the condition being addressed in the CER. When this search did not identify relevant evidence summaries, we searched using other relevant terms to identify any evidence summaries for which the CER would be relevant. We typically did not review evidence summaries on specific interventions, such as specific drugs or drug classes, unless a specific condition was not addressed in the CER. We reviewed the relevant evidence summaries provided in each POC tool to determine and document whether the CER report and/or journal article(s) were cited. We also noted the date that the POC evidence summary was updated to compare timing of the POC update relative to publication of the CER products.\nWe prepared tables documenting CER use across topic, POC tool, and publication year. Patterns of use are numerically summarized by CER and POC tool. We also include a narrative summary of findings within each product to provide more information than possible with numerical summaries.", "pairs": [], "interleaved": []}
+{"file": "methrespoc_NBK206754/fm.s1.nxml", "text": "The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.\nTo improve the scientific rigor of these evidence reports, AHRQ supports empiric research by the EPCs to help understand or improve complex methodologic issues in systematic reviews. These methods research projects are intended to contribute to the research base in and be used to improve the science of systematic reviews. They are not intended to be guidance to the EPC program, although may be considered by EPCs along with other scientific research when determining EPC program methods guidance.\nAHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. The reports undergo peer review prior to their release as a final report.\nWe welcome comments on this Methods Research Project. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to \n\nRichard G. Kronick, Ph.D.\nDirector\nAgency for Healthcare Research and Quality\nStephanie Chang, M.D., M.P.H.\nDirector, EPC Program\nCenter for Outcomes and Evidence\nAgency for Healthcare Research and Quality\nYen-pin Chiang, Ph.D.\nActing Director, Center for Outcomes and Evidence\nAgency for Healthcare Research and Quality\nElisabeth Kato, Ph.D.\nTask Order Officer\nCenter for Outcomes and Evidence\nAgency for Healthcare Research and Quality", "pairs": [], "interleaved": []}