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Using meta-analyses for comparative effectiveness research
Vicki S. Conn, PhD, RN, FAAN*, Todd M. Ruppar, PhD, RN, GCNS-BC, Lorraine J. Phillips, PhD, RN, Jo-Ana D. Chase, MN, APRN-BC
Meta-Analysis Research Center, School of Nursing, University of Missouri, Columbia, MO
a r t i c l e i n f o
Article history: Received 30 December 2011 Revised 16 April 2012 Accepted 22 April 2012
Keywords: Comparative effectiveness research Meta-analysis
* Corresponding author: Dr. Vicki S. Conn, A Center, S317 School of Nursing, University o
E-mail address: email@example.com (V.S.
0029-6554/$ – see front matter � 2012 Elsevi doi:10.1016/j.outlook.2012.04.004
a b s t r a c t
Comparative effectiveness research seeks to identify the most effective inter- ventions for particular patient populations. Meta-analysis is an especially valuable form of comparative effectiveness research because it emphasizes the magnitude of intervention effects rather than relying on tests of statistical significance among primary studies. Overall effects can be calculated for diverse clinical and patient-centered variables to determine the outcome patterns. Moderator analyses compare intervention characteristics among primary studies by determining whether effect sizes vary among studies with different intervention characteristics. Intervention effectiveness can be linked to patient characteristics to provide evidence for patient-centered care. Moderator anal- yses often answer questions never posed by primary studies because neither multiple intervention characteristics nor populations are compared in single primary studies. Thus, meta-analyses provide unique contributions to knowl- edge. Although meta-analysis is a powerful comparative effectiveness strategy, methodological challenges and limitations in primary research must be acknowledged to interpret findings.
Cite this article: Conn, V. S., Ruppar, T. M., Phillips, L. J., & Chase, J.-A. D. (2012, AUGUST). Using meta-
analyses for comparative effectiveness research. Nursing Outlook, 60(4), 182-190. doi:10.1016/
Despite remarkable scientific advances over recent decades, the effectiveness of many health interven- tions remains unclear. The Institute of Medicine noted that evidence of effectiveness exists for less thanhalf of the interventions in use today.1 Scant evidence exists comparingmultiple possible interventions for the same health problem.2 Newer or more costly interventions may not be linkedwith better outcomes, and variations in health care expendituremay be unrelated to changes inhealthoutcomes.3-5The troubling lackof information about interventions’ relative effectiveness led to comparative effectiveness research (CER) initiatives.
ssociate Dean & Potter-B f Missouri, Columbia, MO Conn).
er Inc. All rights reserved
CER can be defined as research designed to discover which interventions work best, under what circum- stances, for whom, and at what cost.1,6 CER methods include randomized, controlled trials; nonrandomized comparison studies; prospective and retrospective observational studies; analyses of registry and practice datasets; practice-based evidence studies; and meta- analyses.6-9 This paper examines using meta-analytic approaches for CER. Examples of nurse-led meta- analyses will be used to demonstrate key points. The paper begins with an explanation of meta-analytic overall effect size estimates for CER, especially in
rinton Distinguished Professor, Director, Meta-Analysis Research 65211.