Journal of clinical epidemiology
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The need to identify how best to structure health insurance and to deliver health care services is a central priority for comparative effectiveness research. Studies designed to evaluate these issues are frequently conducted in large insurance systems. We sought to describe the challenges faced when conducting trials in this context. ⋯ Studies in insurance settings are a powerful and necessary design for evaluating comparative effectiveness interventions. There are numerous strategies to address the potential logistical and methodological challenges that this research environment uniquely creates.
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This article presents the current state of patient-reported outcome measures and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. ⋯ The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other electronic health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization.
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Comparative Study
Stepped wedge designs could reduce the required sample size in cluster randomized trials.
The stepped wedge design is increasingly being used in cluster randomized trials (CRTs). However, there is not much information available about the design and analysis strategies for these kinds of trials. Approaches to sample size and power calculations have been provided, but a simple sample size formula is lacking. Therefore, our aim is to provide a sample size formula for cluster randomized stepped wedge designs. ⋯ For CRTs, the stepped wedge design is far more efficient than the parallel group and ANCOVA design in terms of sample size.
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We evaluated the inter-rater reliability (IRR) of assessing the quality of evidence (QoE) using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. ⋯ Our findings suggest that trained individuals using the GRADE approach improves reliability in comparison to intuitive judgments about the QoE and that two individual raters can reliably assess the QoE using the GRADE system.
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Review
Systematic reviews supporting practice guideline recommendations lack protection against bias.
To evaluate the quality of systematic reviews (SRs) affecting clinical practice in endocrinology. ⋯ Few recommendations in endocrinology are supported by SRs. The quality of SRs is suboptimal and is not acknowledged by guideline developers.