Final Research Report
View this project's final research report.
Results of This Project
Related Journal Citations
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 reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked why the 18-month follow-up period was broken into three 6-month segments and questioned the validity of extrapolating from the 18-month period to 3 years. The researchers explained that they used 6-month intervals to see if an observed change was consistent over time or if there was a lag period before an effect was seen. The researchers said they extrapolated from 18 months because their study had to be completed in a restricted time frame. The reviewers continued to express concern about this extrapolation to 3-year outcomes, and the researchers removed reference to 3 years from the report.
- The reviewers questioned the exclusion of women from the study who had screening at intervals averaging more than 30 months, many of whom were likely not having screening enough and suggested conducting statistical analyses including these women. The researchers agreed that many of the women at such sites were likely underscreened but observed that the purpose of their study was to examine overscreening, not underscreening. The researchers said they excluded clinics that were already screening at the recommended 3-year intervals. Since they excluded those clinics from the beginning of the study, the researchers had no access to data from the sites and could not perform any additional analyses of these patients.
- The reviewers noted that control participants were not assigned within clinics or practices where the researchers conducted interventions and suggested that the non-random assembly of control groups from outside practices might have introduced bias. The researchers said they designed the study in this way because practices would not participate unless they received some kind of intervention, so the researchers assigned the practices they recruited to one or the other of their two interventions. They then randomly sampled clinics that matched the intervention sites on a set of specific characteristics.
- The reviewers expressed concern that the study gave little consideration to subgroups within the study population and suggested conducting additional exploratory, after-the-fact analyses. The reviewers said they did do subgroup analysis based on patients’ primary language and race, but they did not find other patient characteristics in their dataset that they could analyze for heterogeneity.
- The reviewers wondered about providers’ familiarity with current guidelines regarding cervical screening and asked if there was any information regarding providers’ attitudes and practices before the intervention. The researchers pointed out that they were not able to conduct a formal assessment of providers’ knowledge prior to them receiving the intervention, because the assessment may have comprised an intervention itself. Instead, the study included formal group-based provider orientations, so that all providers received the same information regarding the provider tool.
Conflict of Interest Disclosures
^Anna-Barbara Moscicki was affiliated with University of California, San Francisco when this project was funded.
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