The study team’s research addresses “methods for conduct of systematic reviews of patient-centered comparative effectiveness research topics,” and “research that determines that methods for assuring study questions, outcomes, and interventions are meaningful to patients and other stakeholders.” The majority of people with one chronic condition have multiple conditions, and care that focuses on one condition at a time is not patient-centered because patients and their families do not view each condition in isolation. Our existing evidence base fails to adequately inform patient-centered care of people with multiple chronic conditions (MCCs). Estimating the benefit–harm balance of interventions for people with MCCs is challenging for patients and families, clinicians, systematic reviewers, and guideline developers. Systematic reviews and meta-analyses synthesize all available high-quality evidence addressing a particular question in a transparent and scientific manner, and should directly inform the deliberations of guideline development groups. However, addressing the needs of people with MCCs is challenging given our current evidence-based medicine processes and methods. Recent work by the team has described stakeholder-informed methodological approaches for evidence synthesis and the process of developing guidelines specifically for people with MCCs. But these approaches have not yet been implemented within the context of actual evidence syntheses linked to trustworthy guideline development.
With our stakeholder co-investigators, we will identify high-priority clinical questions and outcomes for people with MCCs, and we will synthesize the evidence base to support the development of clinical practice guidelines that can better inform patient-centered care for people with MCCs.
Objective: Our objective is to perform research on methods to improve the validity of systematic reviews of patient-centered research for people with MCCs, and improve the translation of the knowledge in the systematic reviews into guidelines that can be better used to inform patient-centered care for people with MCCs. Through case studies, we will generate useful, evidence-based guidance to inform patient-centered care of people with MCCs for two important clinical questions.
The study aims to:
- Collaborate with people with MCCs, caregivers, and Kaiser Permanente’s National Guideline Program and set priorities for important topics for people with MCCs, one of which is a cardiovascular condition.
- Address, in the context of implementing and refining methods of evidence synthesis for people with MCCs, two top-priority topics for people with MCCs using innovative, stakeholder-informed approaches for evidence synthesis and multidimensional benefit–harm assessment.
- Evaluate and refine the methods used in Aims 1 and 2 based on their implementation, and develop guidance for systematic reviewers and guideline developers.
Bennett WL, Robbins CW, Bayliss EA, et al., Engaging Stakeholders to Inform Clinical Practice Guidelines That Address Multiple Chronic Conditions, Journal of General Internal Medicine (March 2017).