Cross design synthesis : a new strategy for medical effectiveness research : report to Congressional requesters / United States General Accounting Office.

  • United States. General Accounting Office.
Date:
[1992]
Catalogue details

Licence: Public Domain Mark

Credit: Cross design synthesis : a new strategy for medical effectiveness research : report to Congressional requesters / United States General Accounting Office. Source: Wellcome Collection.

    7/128 (page 5)
    GAO’s Analysis complementary strengths and weaknesses: randomized studies and data base analyses. Randomized studies can provide the scientific rigor needed to evaluate how well a treatment works, but their results may not be fully generalizable to the varied conditions of medical practice. Data base analyses are potentially weak because patients are not randomly assigned to alternative treatments. “Imbalanced comparison groups” may result. If corrected for this problem, the results of many data base analyses would be highly generalizable to actual medical practice. GAO’s review of study designs also showed that considerable work has been done in combining research results across existing studies. This work, known as meta-analysis or quantitative “overview,” specifies ways of combining results from similar studies and, to some extent, across more diverse study designs. Building on findings from the review of designs, GAO devised a strategy that extends the logic of meta-analysis. The new strategy, which GAO terms “cross design synthesis” and presents in this report, combines results from studies that have different, complementary designs. The goal of this strategy is to capture the strengths of the different designs, while minimizing weaknesses. This goal is pursued by capitalizing upon numerous existing techniques for assessing, adjusting, and combining the results of existing studies. To gauge the feasibility of cross design synthesis, GAO developed a methodology for combining results from two complementary designs—randomized studies and data base analyses. This methodology is designed to answer the following research question: Does the treatment “work” across the full range of patients for whom it is intended? Based on the methodology presented here, along with a review of this work by a panel of experts, GAO concludes that cross design synthesis is indeed a feasible strategy. Drawing upon established and lesser known techniques from methodological and substantive literature in a number of fields, GAo identified the methods necessary for a synthesis of randomized studies and data base analyses. GAO brought these methods together in a series of