Abstract:
BACKGROUND:Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by systematic review groups to navigate common challenges and enhance impacts of systematic review findings. OBJECTIVES:Describe pragmatic approaches taken by Department of Veterans Affairs Evidence Synthesis Programs (VA ESP) in conducting systematic reviews of effectiveness and implementation barriers and facilitators for complex interventions to provide VA stakeholders with evidence to guide national health care practice and policy. RESULTS:We describe 3 systematic reviews conducted by VA ESP teams to evaluate the evidence for complex health care interventions. We summarize key findings, implications for future research needs and policy, dissemination of findings, and approaches taken to address common challenges. The VA ESP experience adds to existing systematic review methods and provides a perspective on generating rigorous and relevant reviews of complex interventions. CONCLUSIONS:Reviews of complex interventions often encounter challenges related to sources of variability in many dimensions, and lack of clarity and information in reporting of intervention elements, local context, and implementation factors. Evidence synthesis teams should work closely with stakeholders to understand their needs, synthesize and interpret results in meaningful ways, and explore implications that are most relevant for day-to-day clinical practice and operational decisions of learning health care systems. More evaluation of the impact of systematic reviews may improve uptake of findings from future reviews and enhance translation of evidence into practice and policy.
journal_name
Med Carejournal_title
Medical careauthors
Wilt TJ,Greer N,Duan-Porter Wdoi
10.1097/MLR.0000000000001158subject
Has Abstractpub_date
2019-10-01 00:00:00pages
S278-S285eissn
0025-7079issn
1537-1948pii
00005650-201910001-00015journal_volume
57 Suppl 10 Suppl 3pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:BACKGROUND:Since COVID-19 has caused dramatic changes in everyday life, a major concern is whether patients have adequate access to mental health care despite shelter-in-place ordinances, school closures, and social distancing practices. OBJECTIVES:The aim was to examine the availability of telehealth services at outp...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001512
更新日期:2021-01-21 00:00:00
abstract:BACKGROUND:The challenges facing healthcare in the 21st century frequently seem intractable and insurmountable. Systemic problems impair the quality and continuity of care and caregivers' quality of life. For over 25 years, the Clinical Practice Model Resource Center (CPMRC) in Grand Rapids, MI, has focused on transfor...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182239331
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Patients with chronic disease who express stronger preference for their current health might be expected to have better outcomes than patients who assign lower utility to their current health state. OBJECTIVE:We sought to examine associations between preferences for current health and outcomes in a national...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/01.mlr.0000250260.28692.9b
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Indication bias is the major challenge in assessing treatment effectiveness in observational studies. We explored the potential advantages of using an instrumental variable approach in the context of primary androgen deprivation therapy (ADT) for prostate cancer. METHODS:We identified 31,930 men in the link...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318245a086
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Estimates of the costs of medical care vary across patient populations, data sources, and methods. The objective of this study was to compare 3 approaches for estimating the incidence costs of colorectal cancer (CRC) care using similar patient populations, but different data sources and methods. METHODS:We ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a4f482
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES:To identify indivi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318268abe7
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. OBJECTIVES:To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. RESEARCH DESIGN:Cross-sectional and longitudina...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182a977da
更新日期:2014-03-01 00:00:00
abstract::A population-based, retrospective analysis of Medicare Part A and Blue Cross hospital insurance claims data was used to determine whether hospice home care cost savings to third-party insurers are substantial and result from the substitution of less expensive home care visits for more costly hospital inpatient days. T...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198408000-00002
更新日期:1984-08-01 00:00:00
abstract::In this paper the individual is employed as the unit of analysis to examine the extent to which the use of physician care by beneficiaries insured under the Canadian Medicare program is determined by medical needs and sociodemographic characteristics as opposed to economic considerations. The data were derived from th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198311000-00001
更新日期:1983-11-01 00:00:00
abstract:BACKGROUND:Although the life expectancy for the US population has increased, a high proportion of this population has lived with ≥1 chronic conditions. We have quantified the burden of disease associated with 15 chronic conditions and combinations of conditions by estimating quality-adjusted life years (QALYs) for olde...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000943
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Health plans commonly face the conflicting demands of trying to provide access to novel technologies, including new classes of medications, while trying to contain costs. These demands are particularly acute for California's Medicaid program, known as Medi-Cal, which is responsible for delivery of medical ca...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199904001-00005
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:The integration of complementary and alternative medicine (CAM) therapies into a large organization such as the Veterans Health Administration (VHA) requires cultural change and deliberate planning to ensure feasibility and buy-in from staff and patients. At present, there is limited knowledge of VHA patient...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000225
更新日期:2014-12-01 00:00:00
abstract::We evaluated the quality of care of physician's extenders (PEs: 23 physician's assistants, 7 primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs' assuming a considerable portion of the care, formerly provided by physicians in the military medical system. Physician's...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198109000-00007
更新日期:1981-09-01 00:00:00
abstract:BACKGROUND:Travel time, an access barrier, may contribute to attrition of women veterans from Veterans Health Administration (VHA) care. OBJECTIVE:We examined whether travel time influences attrition: (a) among women veterans overall, (b) among new versus established patients, and (c) among rural versus urban patients...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000296
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. METHODS:The patients' characteristics in an urban ED were collect...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200502000-00010
更新日期:2005-02-01 00:00:00
abstract::This article assesses the extent to which formally provided comprehensive community care tends to substitute for informal care provided by family and friends to impaired elderly persons living in the community. Using simultaneous equations causal modeling techniques to control for selective targeting and other interve...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198306000-00003
更新日期:1983-06-01 00:00:00
abstract::In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation ...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199203000-00004
更新日期:1992-03-01 00:00:00
abstract::To compare the utilization of an imaging technology in the United States and Canada and its effect on clinical outcomes, trends in the utilization of mammography among women aged 50 to 75 years from 1984 through 1988 in Washington State and British Columbia were examined. Also compared were trends in the stage at time...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199204000-00003
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health s...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000693
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Performance measures often fail to account for legitimate reasons why patients do not achieve recommended treatment targets. METHODS:We tested a novel performance measurement system for blood pressure (BP) control that was designed to mimic clinical reasoning. This clinically guided approach focuses on (1) ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318245a147
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:The primary objective of this study was to examine veterans' reliance on health care services provided by the Veterans Health Administration (VHA) within Minnesota and estimate the potential effect on uninsurance rates if all eligible veterans relied on VHA coverage. Secondary objectives were to compare vete...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000170403.97264.39
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Teamwork in health care settings is widely recognized as an important factor in providing high-quality patient care. However, the behaviors that comprise effective teamwork, the organizational factors that support teamwork, and the relationship between teamwork and patient outcomes remain empirical questions...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0b013e31827feef6
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:To investigate patterns of complementary and alternative medicine (CAM) use disclosure across medical and sociobehavioral factors and to provide a model that takes into account factors in explaining those patterns. SUBJECTS:A total of 21,849 CAM use episodes from 7347 respondents in the 2007 US National Heal...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000165
更新日期:2014-08-01 00:00:00
abstract::Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying ou...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVE:To investigate differences in self-rated health (SRH) between web and mail questionnaires in a mixed mode survey and to provide a model that explains those differences. SUBJECTS:A total of 15,200 mail respondents and 17,829 web respondents from the 2008 US National Health Survey conducted by the Gallup Panel...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31829a4f92
更新日期:2013-09-01 00:00:00
abstract::The techniques of cost-effectiveness are employed to simplify resource allocation decisions concerned with the use of land and air transport systems in the health services of a developing country. Outcome classifications are produced for patients seen by mobile and fixed primary care units. The mobile services examine...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197704000-00001
更新日期:1977-04-01 00:00:00
abstract::Although Alzheimer's-type dementia (ATD) is characterized by global intellectual deterioration, few systematic efforts have been made to characterize overall dysfunction of ATD patients. The Sickness Impact Profile (SIP) was administered to ATD patients and family members to determine the concurrent validity of family...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198805000-00002
更新日期:1988-05-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to identify hospital organizational characteristics consistently associated with adherence to multiple clinical practice guidelines (CPGs). We examined the relationship between organizational and patient population characteristics and adherence to three screening CPGs implemented...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200212000-00005
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:While standard methods for conducting economic evaluations have evolved, little attention has been paid to the conduct of these studies in special populations such as children. OBJECTIVES:To build a database of pediatric economic evaluations and to examine trends in publication characteristics over a 20-yea...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000088451.56688.65
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:If shape of a person's utility function is associated with his health status, as is predicted by Prospect Theory, the use of utilities from the healthy could result in 'de facto' discrimination against the sick. OBJECTIVES:To determine if patients' utilities for hypothetical states and for their current hea...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199905000-00007
更新日期:1999-05-01 00:00:00