Qualitative Evidence Syntheses Within Cochrane Effective Practice and Organisation of Care: Developing a Template and Guidance

A growing number of researchers are preparing systematic reviews of qualitative evidence, often referred to as ‘qualitative evidence syntheses’. Cochrane published its first qualitative evidence synthesis in 2013 and published 27 such syntheses and protocols by August 2020. Most of these syntheses have explored how people experience or value different health conditions, treatments and outcomes. Several have been used by guideline producers and others to identify the topics that matter to people, consider the acceptability and feasibility of different healthcare options and identify implementation considerations, thereby complementing systematic reviews of intervention effectiveness.Guidance on how to conduct and report qualitative evidence syntheses exists. However, methods are evolving, and we still have more to learn about how to translate and integrate existing methodological guidance into practice. Cochrane’s Effective Practice and Organisation of Care (EPOC) ( www.epoc.org ) has been involved in many of Cochrane’s qualitative evidence syntheses through the provision of editorial guidance and support and through co-authorship. In this article, we describe the development of a template and guidance for EPOC’s qualitative evidence syntheses and reflect on this process.

OP103 Incorporating Health Technology Assessment In The Development Of A Clinical Care Pathway

IntroductionClinical care pathways (CPWs) provide a step-wise multidisciplinary care plan for patients with a particular health condition. Their aim is to optimize patient outcomes and organization of care by supporting evidence-based practice. It therefore seems inevitable that health technology assessment (HTA) should be incorporated within the development process of a CPW. As CPWs become increasingly utilized, there is a need to understand the added value and strategies to integrating HTA in the development of a CPW.MethodsThrough a case study of an HTA on treatments for chronic low back pain requested as part of the development of a CPW for chronic musculoskeletal pain, we demonstrated the three key strategies to include HTA in CPWs described by Rehaluk 2016 and added a fourth one. We then showed how these strategies contribute to the development of a CPW which answers the quality criteria outlined by the Cochrane Effective Practice of Care group through a strength, weaknesses, opportunities, and threats analysis.ResultsWe confirmed four key strategies to including HTA in CPWs (organizational positioning of the HTA unit, partnership and communication with stakeholders, tailoring the integration of contextual data with evidence from the literature, explore tools to facilitate the use of HTA findings). The inclusion of HTA through these strategies contributes to the development of a CPW which meets the ten criteria to evaluate the quality of a CPW outlined by the Cochrane Effective Practice of Care group. Through a strength, weaknesses, opportunities, and threats analysis, we describe how each of the criteria were met and how this led to recommendations influencing our regional organization of care.ConclusionsThe inclusion of HTA in CPW development increases its capacity to directly influence organization of care. HTA can represent a pivotal vehicle to ensure good quality CPWs.

Den norske EPOC-satellitten: støtte til kunnskapsbaserte beslutninger

<p>Systematiske oversikter fra det internasjonale Cochrane-samarbeidet er en viktig kilde til oppsummert kunnskap for beslutningstakere i helsevesenet. Den norske satellitten av Cochrane Effective Practice and Organisation of Care (EPOC) Review Group har base i Seksjon for global helse, Nasjonalt kunnskapssenter for helsetjenesten, og fokuserer på tiltak som retter seg mot helsesystemer og helsetjenesten i lav- og mellominntektsland. Den norske EPOC-satellitten gir redaksjonell støtte til forfattere som skriver Cochraneoversikter om effekter av slike tiltak, og bidrar dermed til at systematiske oversikter blir utarbeidet og brukt. Behovet for oppsummert kunnskap, skreddersydd for ulike sammenhenger og ulike sluttbrukere, er stort. Ikke minst gjelder det i lav- og mellominntektsland der ressursene er begrenset, og der gode prioriteringer er spesielt viktig.</p><p>Munabi-Babigumira S, Johansen M, Paulsen E. <strong>The Norwegian EPOC-satellite: Support for evidenceinformed decisions</strong>. <em>Nor J Epidemiol</em> 2013; <strong>23</strong> (2): 211-214.</p><p><strong>ENGLISH SUMMARY</strong></p><p>Systematic reviews from the Cochrane Collaboration are an important source of summarised evidence for decision makers in health care. The Norwegian satellite of the Cochrane Effective Practice and Organisation of Care (EPOC) Review Group has its base at the Global Health Unit in the Norwegian Knowledge Centre for the Health Services, and focuses on interventions targeting health systems and services in lowand middle-income countries. The Norwegian EPOC-satellite provides editorial support to authors who write systematic reviews on the effects of such interventions, and contributes to building the capacity for producing and using systematic reviews. The need for summarised evidence, tailored for various settings and various end users, is large. This is particularly important for low- and middle income countries, where resources are limited and it is important to identify the right priorities.</p>

Implementeringsforskning: vitenskap for forbedring av praksis

<p>Medisinsk forskning har ført til store framskritt de siste tiårene. Det er investert mye mer ressurser på basalforskning og klinisk forskning enn på å utvikle og evaluere metoder for å sikre at pasientene får nytte av forskningen. Formålet med implementeringsforskning er å redusere gapet mellom forskning og praksis, ved å utvikle og evaluere tiltak som kan sikre at behandlingen som pasientene mottar er kunnskapsbasert, at den er omsorgsfull og av god kvalitet.</p><p>I denne artikkelen gjør vi rede for hva implementering og implementeringsforskning er. Vi belyser historikken til denne unge vitenskapen, og illustrerer mangfoldet i de faglige tilnærmingene og begrepene som brukes om det å få forskning brukt i praksis. Det finnes en rekke teorier om endring av atferd, både på individnivå og på organisatorisk nivå. Teoriene er imidlertid i liten grad testet empirisk, særlig når det gjelder å endre atferd i helsetjenesten.</p><p>Systematiske oversikter over metodisk gode studier er den beste kilden til informasjon om effekt av implementeringstiltak. The Cochrane Effective Practice and Organisation of Care Group (EPOC) er en viktig kilde for slike oversikter. De systematiske oversiktene som er utarbeidet på dette feltet viser at passive dissemineringstiltak har begrenset effekt, mens mer aktive tiltak kan ha liten til moderat effekt. Det er ofte betydelig variasjon i effekt på tvers av studiene. Det er derfor viktig å få bedre kunnskap om hvilke faktorer som kan forklare slike forskjeller i effekt.</p><p>Vi gir eksempler på norske implementeringsstudier, og refererer bidrag fra forskere ved Kunnskapssenteret. Implementeringsforskningen kan, hvis den lykkes, sikre pasientene bedre behandling.</p><p>Flottorp S, Aakhus E. <strong>Implementation research: science for improving practice</strong>. Nor J Epidemiol 201 3; <strong>23</strong> (2): 187-196.</p><p><strong>ENGLISH SUMMARY </strong></p><p>Medical research has led to major advances in recent decades. More resources have been invested in basic and clinical research than into the development and evaluation of methods to ensure that patients benefit of research findings. The purpose of implementation research is to reduce the gap between research and practice, by developing and evaluating measures to ensure that the treatment patients receive is evidencebased, caring and of high quality.</p><p>In this article, we briefly explain implementation and implementation research. We illustrate the history of this young science, and the diversity of academic approaches and concepts used when trying to get research into practice. There are a number of theories about behavioural change, both at the individual and organisational level. The theories are, however, rarely tested empirically, especially when it comes to changing behaviour in the health services.</p><p>Systematic reviews of methodologically rigorous studies are the best source of information about the effects of implementation interventions. The Cochrane Effective Practice and Organisation of Care Group (EPOC) is a major source of such reviews. The systematic reviews that have been produced in this area indicate that passive dissemination has limited impact, while more active interventions may have small to moderate effects. There is often considerable variation in the effects across studies. It is therefore important to gain better knowledge of the factors that may explain such effect-differences.</p><p>We give examples of Norwegian implementation studies, and refer contributions from researchers at the Norwegian Knowledge Centre for the Health Services. Implementation research has the potential, if successful, to ensure that patients receive better health care.</p>

Australian health policy makers’ priorities for research synthesis: a survey

Objectives. Health policy making is complex, but can be informed by evidence of what works, including systematic reviews. We aimed to inform the work of the Cochrane Effective Practice and Organisation of Care (EPOC) Group by identifying systematic review topics relevant to Australian health policy makers and exploring whether existing Cochrane reviews address these topics. Methods. We interviewed 30 senior policy makers from State and Territory Government Departments of Health to identify topics considered important for systematic reviews within the scope of health services research, including professional, financial, organisational and regulatory interventions to improve professional practice and the organisation of services. We then looked for existing Cochrane reviews relevant to these topics. Results. Eighty-five priority topics were identified by policy makers, including advanced practice roles, care for Indigenous Australians, care for chronic disease, coordinating across jurisdictions, admission avoidance, and eHealth. Sixty published Cochrane reviews address these issues, and 34 additional reviews are in progress. Thirty-four topics are yet to be addressed. Conclusions. This survey has identified questions for which Australian policy makers have indicated a need for systematic reviews. Further, it has confirmed that existing reviews do address issues of importance to policy makers, with the potential to inform policy processes. What is known about the topic? Evidence-informed policy making is a complex process, requiring integration of relevant evidence in the context of multiple influences, inputs and priorities. Communication between policy makers and researchers is likely to increase the availability of relevant research evidence for policy, and improve its uptake into action. The Cochrane Effective Practice and Organisation of Care Group produces systematic reviews in areas intersecting with key policy responsibilities, including professional, financial, organisational and regulatory interventions designed to improve health professional practice and the organisation of healthcare services, and seeks to engage with policy makers to identify their research priorities. What does this paper add? This study surveyed Australian health policy makers from each of the Australian State and Territory Government Departments of Health, and identified 85 policy questions for which they considered systematic reviews of the evidence would be useful. Relevant to these topics, 60 existing published Cochrane systematic reviews were identified, as well as 34 reviews in progress, and 34 topics not yet addressed. The study also identified those published reviews that could not reach definitive conclusions, indicating that more primary research is required. What are the implications for practitioners? For researchers, areas of need for new systematic reviews have been identified. For policy makers, a suite of relevant systematic reviews have been identified that may be of use in policy processes.