Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer review identified the following strengths and limitations in the report:

• The reviewers asked the researchers to provide more rationale for the multivariate analyses the study chose. The researchers responded by stating that they chose to use ordered logistic regression for their main analyses. The researchers explained that the Communication Climate Assessment Toolkit scores were categorical rather than continuous, so treating the scores as continuous could introduce bias into calculations. The researchers also provided their rationale for controlling for some factors and not others. The rationale was that the sample size for some factors may have been too small for adequate power to detect meaningful differences.
• The reviewers expressed concern that the researchers stratified results by sex for the homosexual group but not for the bisexual and heterosexual groups. The researchers explained that their decision came after recommendations from stakeholders as well as from peer reviewers for journal articles about this study. In addition, the researchers expressed concern that stratifying by sex in the bisexual group would lead to small sample sizes with insufficient power to detect meaningful differences.
• The reviewers noted that the report did not describe how the researchers addressed the effects of missing data on the results. The reviewers asked for more information about such effects. The researchers responded that they matched groups using only participants with complete data, so missing data did not raise issues. The researchers chose this strategy because they predicted that inputting data for missing variables was just as likely to increase bias in the sample as it was to alleviate it.
• The reviewers were unclear about how many patients in the emergency department either weren’t asked about their sexual orientation or gender identity or declined to answer those questions. The researchers acknowledged that this lack of clarity was a limitation of the study. The researchers added that 88 percent of patients in the emergency department were not asked these questions, while 0.01 percent refused to answer. The researchers explained that patients were not asked despite the researchers’ efforts to make the questions about sexual orientation and gender identity part of routine intake procedures. However, the researchers did not believe this low rate of asking patients significantly affected the results. The team still achieved the planned sample size and produced the same communication climate results with every analysis of the data.

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