The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care (EHC) Program conducts systematic reviews on a range of health care topics. Topics are nominated by a variety of stakeholders. Nominated topics undergo a refinement process to ensure that the Key Questions are relevant, of appropriate scope, and will ultimately yield a useful systematic review. Topic refinement investigators gather input from Key Informants, topical experts, and a literature scan to inform changes in the PICOTS (population, intervention, comparator, outcomes, timing, and setting), analytic framework and Key Questions. Evidence-based Practice Centers (EPCs) have approached the topic refinement process in similar and different ways. AHRQ convened a work group to assess current approaches and to develop recommendations for best practices; we report our findings here.
We formed a workgroup of four investigators from four different EPCs in the United States and Canada and one AHRQ Project Officer. All participants held experience in topic refinement. We generated a prioritized list of methodological questions and possible guiding principles considered in the topic refinement process. We discussed each issue until we reached agreement.
A refined topic should address an important health care question or dilemma; consider the priorities and values of relevant stakeholders; reflect the state of the science; and be consistent with systematic review research methods. The guiding principles of topic refinement are: fidelity to the original nomination, public health and/or clinical relevance, research feasibility, responsiveness to stakeholder input, reducing investigator bias, transparency, and suitable scope. We describe the mechanics of the topic refinement process, and discuss approaches and variability in methods used by EPCs to engage Key Informants, integrate and synthesize input, and report findings. Practical suggestions and challenges in preparing and recruiting Key Informants, facilitating engagement, synthesis, and reporting are described and discussed. Decisions about integrating input from various sources require investigator judgment in the application and balance of the guiding principles. The relative importance and application of these principles will vary by topic and purpose of the systematic review. Variability in topics precludes a prescriptive approach to application of the guiding principles. Transparency and consistent documentation of decisions are important for public accountability and integrity of the topic refinement process.
Systematic reviews that are accurate, methodologically rigorous, and as relevant and useful as possible for stakeholders require that topics be well refined. This report details guiding principles and methodological recommendations that may help investigators to better refine topics for systematic reviews, both within and outside of the EHC Program.
