Results Summary and Professional Abstract
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 for more details on how patients influenced the study. The researchers explained that the patient advisory board did not influence the study design but offered other feedback and input over the course of the four -year project, for example in helping to develop the clinician training and in interpreting findings. The researchers also engaged the patient advisory board to help develop the project’s public-facing website and to help plan the social media strategy that will be used when the study’s results are published.
- The reviewers said the quantitative study design was unclear and that the study may not have been a stepped-wedge design as described. The researchers added details about the study design to their report and asserted that the quantitative study was indeed a stepped-wedge cluster randomized trial (SW-CRT) because it fit three criteria: randomization at the level of clusters; all clusters transitioned from control phase to intervention phase; and the point of randomization was the order in which clinics transitioned to the intervention condition, rather than whether or not clinics received the intervention. The researchers noted that the open cohort design by which patients entered treatment in the clinics still fell under the SW-CRT model.
- The reviewers questioned the value of the researchers’ use of a summary risk variable that grouped together different types of health behaviors for analysis. The researchers responded that most studies have examined highly limited outcomes, but primary care clinicians address a wide range of behaviors in a short amount of time. There has been no evidence if this kind of wide-ranging advice makes any difference in the health of youth. The researchers said that everyone involved in the study was very interested in understanding how to improve the value of primary care visits. They also noted that the first step in doing so is to measure the impact of screening and feedback in a structured way, which is what this study did.
- The reviewers pointed out that with five clusters to compare and little room for improvement among the adolescent participants, the researchers should consider the study to not have met its objectives or at least state that there were no meaningful differences between intervention and comparison groups. The researchers disagreed, noting that although the number of significant outcomes was small, these outcomes were important clinically. The researchers did revise the report to acknowledge some of the limitations to the interpretation of results, including the larger number of outcomes that did not show significant differences, and the questionable validity for the summary health risk measure.
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