236 lines
21 KiB
HTML
236 lines
21 KiB
HTML
<!doctype html>
|
|
<!--[if lt IE 7]> <html class="no-js lt-ie9 lt-ie8 lt-ie7" lang="en"> <![endif]-->
|
|
<!--[if IE 7]> <html class="no-js lt-ie9 lt-ie8" lang="en"> <![endif]-->
|
|
<!--[if IE 8]> <html class="no-js lt-ie9" lang="en"> <![endif]-->
|
|
<!-- Consider adding a manifest.appcache: h5bp.com/d/Offline -->
|
|
<!--[if gt IE 8]><!--> <html class="no-js" lang="en"> <!--<![endif]-->
|
|
<head>
|
|
<meta charset="utf-8">
|
|
|
|
<meta name="perc_linkback" id="perc_linkback" content="FmZlbWNteAdmeAFjZ2x4BmZnYHgTZ2JjbGQ="/> <!-- Use the .htaccess and remove these lines to avoid edge case issues. More info: h5bp.com/i/378 -->
|
|
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
|
|
<title>Chapter 2. Methods | AHRQ Archive</title>
|
|
<meta name="title" content="Chapter 2. Methods | AHRQ Archive">
|
|
<meta name="description" content="This contract final report identifies criteria for assessing the context-sensitive effectiveness and safety of patient safety practices and presents recommendations for future research on this topic.">
|
|
|
|
<!-- Mobile viewport optimized: h5bp.com/viewport -->
|
|
<meta name="viewport" content="width=device-width">
|
|
<!-- link rel="stylesheet" href="/css/style.css" -->
|
|
|
|
<!-- More ideas for your <head> here: h5bp.com/d/head-Tips -->
|
|
<!-- All JavaScript at the bottom, except this Modernizr build.
|
|
Modernizr enables HTML5 elements & feature detects for optimal performance.
|
|
Create your own custom Modernizr build: www.modernizr.com/ -->
|
|
<script src="/js/libs/modernizr-2.5.3.min.js"></script>
|
|
|
|
<!-- "metadata" -->
|
|
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, access, adverse outcomes, ambulatory care, benchmark, best practices, blood clots, CAHPS, case studies, chronic care, complication, conditions, Consumer Assessment of Health Plans, disparities, error, HAI, health cost, hepatitis, hospital procedure, health care-associated infections, indicators, infection, insurance, measures, medical errors, methodology, nursing, patient care, patient safety, performance measure, quality, study, survey, thrombosis, treatment, urgent care" />
|
|
<meta name="creator" content="Agency for Healthcare Research and Quality (AHRQ)">
|
|
<meta name="datecreated" content="September 2012">
|
|
<meta name="datereviewed" content="November 2014">
|
|
<meta name="language" content="en-us">
|
|
<!-- end="metadata" -->
|
|
<link rel="stylesheet" href="/css/archive.css">
|
|
<link rel="stylesheet" href="/css/ahrqstyleprint_arch.css" media="print">
|
|
<script>
|
|
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
|
|
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
|
|
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
|
|
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
|
|
|
|
ga('create', 'UA-75759936-1', 'auto');
|
|
ga(' set', 'anonymizeIp', true);
|
|
|
|
ga('send', 'pageview');
|
|
|
|
</script></head>
|
|
<body><!-- Google Tag Manager -->
|
|
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
|
|
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
|
|
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
|
|
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
|
|
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
|
|
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
|
|
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
|
|
<!-- End Google Tag Manager -->
|
|
<!-- Prompt IE 6 users to install Chrome Frame. Remove this if you support IE 6.
|
|
chromium.org/developers/how-tos/chrome-frame-getting-started -->
|
|
<!--[if lt IE 7]><p class=chromeframe>Your browser is <em>ancient!</em> <a href="http://browsehappy.com/">Upgrade to a different browser</a> or <a href="http://www.google.com/chromeframe/?redirect=true">install Google Chrome Frame</a> to experience this site.</p><![endif]-->
|
|
|
|
<!-- Add your site or application content here -->
|
|
<noscript>Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.</noscript>
|
|
<!-- Page Header v2.0 --><!--Begin Banner CodeS-->
|
|
<div id="ahrqbanner">
|
|
<div class="hhsportion" id="top" name="top">
|
|
<a class="skipnav" href="#h1">Skip Navigation</a>
|
|
<a title="Archive: U.S. Department of Health and Human Services" href="http://archive.hhs.gov/"><img border="0" alt="Archive: U.S. Department of Health and Human Services" src="/images/hhs_banner_arch.gif" width="376" height="49"></a>
|
|
<a class="hhsright" title="U.S. Department of Health and Human Services" href="http://www.hhs.gov/"><img alt="U.S. Department of Health and Human Services" src="/images/hhs_link_arch.gif" width="127" height="41"></a>
|
|
</div>
|
|
<div class="ahrqportion">
|
|
<a title="Archive: Agency for Healthcare Research Quality" href="/"><img border="0" alt="Archive: Agency for Healthcare Research Quality" src="/images/ahrq_banner_arch.jpg" width="566" height="69"></a>
|
|
<form id="banner_searchform" method="get" name="searchForm" action="https://search.ahrq.gov/search">
|
|
<label style="Z-INDEX: -1; POSITION: relative; FONT-SIZE: 0px; MARGIN-RIGHT: -65px" for="search">Search</label>
|
|
<input id="search" class="gotext" onfocus="this.value='';" value=" Search Archive" size="11" type="text" name="q" label="Search archive"/>
|
|
<input type="hidden" name="siteDomain" value="archive.ahrq.gov">
|
|
<input class="gobtn" onclick="javascript:document.searchForm.submit();" alt="Search" src="/images/topbn_GoButton.gif" type="image" name="Submit"/>
|
|
</form><a class="ahrqright" title="AHRQ Home—Live Site" href="http://www.ahrq.gov">www.ahrq.gov</a>
|
|
</div>
|
|
<div class="ahrqlinks">
|
|
<a href="https://www.ahrq.gov/">AHRQ Home—Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a>
|
|
</div>
|
|
</div>
|
|
<div id="PrintBanner"><img alt="Archival print banner" src="/images/printbanner_arch.jpg"/></div><a id="h1" name="h1"></a><!-- End of Page header -->
|
|
<!-- Content Body -->
|
|
<div id="mainContent">
|
|
<!-- Main Content -->
|
|
<!-- Center Content section -->
|
|
<table border="0" cellpadding="0" cellspacing="0" width="100%">
|
|
<tbody><tr valign="top">
|
|
<td width="70%">
|
|
<!-- Center Content section -->
|
|
<table style="margin-left: 10px; margin-right: 10px; margin-top: 5px;" summary="This table gives the layout format of the bread crumb area and the center content area." border="0" cellpadding="0" cellspacing="0" width="100%">
|
|
<!--DWLayoutTable-->
|
|
<tbody><tr>
|
|
<td class="crumb_link"><div id="crumbContent">
|
|
</span></p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td>
|
|
<div id="centerContent">
|
|
<div class="headnote">
|
|
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information.</p>
|
|
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p>
|
|
</div>
|
|
<!-- T:ahrqPgPublication -->
|
|
<div role="main" id="page-container">
|
|
<div id="breadcrumb-container">
|
|
<div id="breadcrumbs" class="container_12">
|
|
<!-- T:SnBreadcrumbs -->
|
|
|
|
|
|
|
|
</div>
|
|
</div>
|
|
<div id="toolbar-container">
|
|
<div id="pub-toolbar" class="container_12">
|
|
<!-- T:ahrqSnPubNav -->
|
|
<div id="prev-next-buttons">
|
|
<a href="/research/findings/final-reports/contextsensitive/context1.html" class="prev-button"><span>Previous Page</span></a>
|
|
<a href="/research/findings/final-reports/contextsensitive/context3.html" class="next-button"><span>Next Page</span></a>
|
|
</div>
|
|
<div id="pub-utility-buttons">
|
|
<ul id="utility-groups">
|
|
<li class="utility content-button">
|
|
<a href="#" class=""><span>Table of Contents</span></a>
|
|
<div class="toc-dropdown">
|
|
<div class="arrow-up"></div>
|
|
<div class="toc-content">
|
|
</div>
|
|
</div>
|
|
</li>
|
|
<li class="utility download-button"><a href="#"><span>Download</span></a><div class="dl-dropdown"><div class="arrow-up"></div><div class="dl-content"><ul><li>
|
|
<span><a href="/research/findings/final-reports/contextsensitive/context.pdf">Assessing the Evidence for Context-Sensitive Effectiveness and Safety </a> [ <img src="/resources/file_logos/pdf.gif" alt="PDF file" title="PDF file" class="icon" /> - 711.65 KB]</span>
|
|
</li></ul></div></div></li> </ul>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div id="page-backdrop" class="container_12">
|
|
<div class="page">
|
|
<div id="left-col" class="alpha grid_3">
|
|
<nav id="left"><!-- T:SnleftNav -->
|
|
</nav> </div>
|
|
<!--<div id="content-col" class="grid_9">-->
|
|
<article class="grid_9">
|
|
<!-- Right Rail -->
|
|
<aside class="three-col">
|
|
<!-- T:ahrqSnPubCover -->
|
|
<div id="pub-nums">
|
|
<ul>
|
|
<li>Publication # 11-0006-EF</li> </ul>
|
|
</div>
|
|
|
|
</aside>
|
|
<!-- Center Rail -->
|
|
<h1>Chapter 2. Methods</h1>
|
|
<h2>Assessing the Evidence for Context-Sensitive Effectiveness and Safety </h2> <div id="basic-modal"><!-- start: Basic Modal -->
|
|
<p>This project represents a collaboration between the project team and an interdisciplinary group of patient safety and methods experts, called the Technical Expert Panel, or TEP. Each key step of the project required both preparatory work on the part of the project team and then consideration and discussion by the TEP, with synthesis of the TEP discussion and decisions then made by the project team. The figures on the following pages give an overview of the methods, which are more fully described in Appendix A, Part 1.</p><p>The five goals of the project were to:</p><ol><li>Form an interdisciplinary panel of experts to assist with all phases of the project.</li><li>Identify a diverse and representative set of patient safety practices (PSPs) to be used as initial subjects. As noted in the RFP, "to help iteratively develop criteria for rigorous and systematic assessment of the context-sensitive effectiveness and safety of PSPs. They should be in actual use, promising in terms of underlying logic models for achieving effectiveness, safety, and generalizability, address high impact and diverse patient safety problems, and represent the contexts in which patient safety is an important concern"</li><li>Identify research and evaluation models, methods and designs to rigorously evaluate the patient safety practices identified and, "in considering research designs and methods," identify or develop approaches that measure contexts and implementation processes in PSP interventions and suggest how collection of contextual and process data needed for assessing the generalizability of the PSP can be combined with designs that are strong on internal and construct validity. Pay close attention to assessing both the positive and negative impacts of PSPs. Pay close attention to identifying appropriated measures of aspects of the PSP."</li><li>Develop a set of criteria, including criteria for strength of evidence, to be used for assessing future studies and reports. Criteria are necessary to guide both (a) future assessments of evidence and safety relative to the effectiveness, implementation, and adoption of the identified types of PSPs; and (b) systematic reviews of patient safety evidence.</li><li>Identify specific needs for future development of theories, constructs, and research/evaluation designs and methods to further strengthen evaluations of PSPs and criteria for systematic review. <a id="fig2" name="fig2"></a></li></ol><p>In <a href="/research/findings/final-reports/contextsensitive/contextfig2.html">Figure 2</a>, the selection of the "diverse and representative patient safety practices" (goal 2 above), the project team used the literature, expert input, and information from other sources (such as the project officer, the RFP, etc.) to develop a list of candidate PSPs. This list was then voted on by the TEP, and the results of the vote were used by the project team to select four PSPs, based on a number of criteria such as setting, regulated use, etc., presented in more detail later. There were remaining questions about the need for a possible fifth PSP, and this too was put to the TEP in an e-mail vote. The results of this process led to the final set of five diverse and representative PSPs, which was affirmed by the TEP. <a id="fig3" name="fig3"> </a></p><p>In <a href="/research/findings/final-reports/contextsensitive/contextfig3.html">Figure 3</a>, regarding evaluation questions, the project team (again using the literature, input from experts, and their own experiences in quality improvement and patient safety research) developed a draft monograph proposing three basic types of evaluation questions. This monograph was reviewed by the TEP and then discussed at the July 17, 2009, TEP teleconference. A revised set of evaluation questions was then prepared reflecting the TEP's input.<a id="fig4" name="fig4"> </a></p><p>In <a href="/research/findings/final-reports/contextsensitive/contextfig4.html">Figure 4</a>, regarding study designs, the project team used existing literature plus input from experts, including key methods experts on the TEP, to come up with a framework of study designs linked to evaluation questions and contexts. The issue about study design continued to be a topic of discussion at the July 17, 2009, TEP teleconference, as well as the November 4-5, 2009, face-to-face TEP meeting. The results informed the report chapter on study design, presented in Appendix I, as well as the criteria for evaluating the body of evidence. An important result of this process was the TEP's recognition that prior arguments conceptualizing the issue as "randomized controlled trials" versus "observational study designs" obscured important elements of assessment that should be included in any well-done evaluation. Another important result of this process was the TEP's agreement on which of those assessment elements were most critical.<a id="fig5" name="fig5"> </a></p><p>In <a href="/research/findings/final-reports/contextsensitive/contextfig5.html">Figure 5</a>, regarding the selection of contexts, the project team again used existing literature, theory, and expert input to come up with a candidate list of potential contexts important for assessment in this project. This list was shortened as a result of TEP input in an Internet survey plus discussion at the July 17, 2009, TEP teleconference. This shortened list was then the subject of a literature review by the project team, assessing the evidence for the influence of these contexts on implementation effectiveness or outcomes. This information helped guide a discussion by the TEP at the November 4-5, 2009, meeting. Subsequently, a revised Internet survey was completed by the TEP, resulting in the final list of contexts.<a id="fig6" name="fig6"> </a></p><p>In <a href="/research/findings/final-reports/contextsensitive/contextfig6.html">Figure 6</a>, regarding selection of criteria for assessing context-sensitivity, the project team took the shortened list of contexts and reviewed available methods of measuring the key contexts that present measurement challenges (teamwork, leadership, patient safety culture, and organizational complexity). This literature review, in addition to the review of evidence developed in <a href="/research/findings/final-reports/contextsensitive/contextfig5.html">Figure 5</a>, was then used by the TEP to select criteria for measuring these contexts. This was done during a discussion at the November 4-5, 2009, TEP meeting and in a subsequent Internet survey.</p><p>Finally, to identify specific needs for future development and research, we first surveyed the project team. We then received feedback from the project officer as well as the project team before surveying the entire TEP after the November 4-5, 2009, meeting.</p> </div><!-- end: Basic Modal -->
|
|
<div class="current-as-of">Page last reviewed December 2010</div>
|
|
<div class="citation">
|
|
<span>Internet Citation: Chapter 2. Methods: Assessing the Evidence for Context-Sensitive Effectiveness and Safety .
|
|
December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/final-reports/contextsensitive/context2.html</span>
|
|
<div class="citation-flag"></div>
|
|
</div>
|
|
</article>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<p> </p>
|
|
<div class="footnote">
|
|
<p> The information on this page is archived and provided for reference purposes only.</p>
|
|
</div>
|
|
<p> </p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
</div><!-- End of Content Body -->
|
|
<!-- Footer graphic 1.2-->
|
|
<table border="0" cellSpacing="0" cellPadding="0" width="100%">
|
|
<tbody>
|
|
<tr>
|
|
<td background="/images/bottom_ahrq_bkg.jpg" width="125">
|
|
<img alt="AHRQ" src="/images/bottom_ahrq_1.jpg" width="125">
|
|
</td>
|
|
<td background="/images/bottom_ahrq_bkg.jpg" width="100%">
|
|
<img alt="" src="/images/bottom_ahrq_bkg.jpg" width="10" height="34">
|
|
</td>
|
|
<td background="/images/bottom_ahrq_bkg.jpg" width="310">
|
|
<img alt="Advancing Excellence in Health Care" src="/images/bottom_ahrq_2.gif" width="310" height="34">
|
|
</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
<!-- Footer links section -->
|
|
<div id="banner_Footer2">
|
|
<p>
|
|
<a href="https://www.ahrq.gov/">AHRQ Home</a> |
|
|
<a class="footer_navlink" href="https://info.ahrq.gov/cgi-bin/ahrq.cfg/php/enduser/std_alp.php">Questions?</a> |
|
|
<a class="footer_navlink" href="https://www.ahrq.gov/contact/index.html">Contact AHRQ</a> |
|
|
<a class="footer_navlink" href="https://www.ahrq.gov/policy/electronic/accessibility/index.html">Accessibility</a> |
|
|
<a class="footer_navlink" href="https://www.ahrq.gov/policy/electronic/privacy/index.html">Privacy Policy</a> |
|
|
<a class="footer_navlink" href="https://www.ahrq.gov/news/foia.htm">Freedom of Information Act</a> |
|
|
<a class="footer_navlink" href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html">Disclaimers</a> |
|
|
<a class="footer_navlink" href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html">Plain Writing Act</a>
|
|
<br/>
|
|
<a class="footer_navlink" href="http://www.hhs.gov">U.S. Department of Health & Human Services</a> |
|
|
<a class="footer_navlink" href="http://www.whitehouse.gov">The White House</a> |
|
|
<a class="footer_navlink" href="http://www.usa.gov">USA.gov: The U.S. Government's Official Web Portal</a>
|
|
</p>
|
|
</div>
|
|
<div id="banner_Footeraddress">
|
|
<p>
|
|
Agency for Healthcare Research and Quality <img alt="" src="/images/bottom_dot.gif"> 5600 Fishers Lane Rockville, MD 20857 <img alt="" src="/images/bottom_dot.gif">
|
|
Telephone: (301) 427-1364
|
|
</p>
|
|
</div>
|
|
<!-- End of Footer links section -->
|
|
|
|
<!-- JavaScript at the bottom for fast page loading: http://developer.yahoo.com/performance/rules.html#js_bottom -->
|
|
<!-- Grab Google CDN's jQuery, with a protocol relative URL; fall back to local if offline -->
|
|
<script src="//ajax.googleapis.com/ajax/libs/jquery/1.7.2/jquery.min.js"></script>
|
|
<script>window.jQuery || document.write('<script src="js/libs/jquery-1.7.2.min.js"><\/script>')</script>
|
|
|
|
<!-- scripts concatenated and minified via build script -->
|
|
<script src="/js/plugins.js"></script>
|
|
<script src="/js/script.js"></script>
|
|
<script src="/scripts/javascript.js"></script>
|
|
<!-- end scripts -->
|
|
</body>
|
|
</html>
|