Setting priorities for comparative effectiveness research: a case study using primary open-angle glaucoma

To test the feasibility of a framework for prioritizing new comparative effectiveness research (CER) questions related to management of primary open-angle glaucoma (POAG) using practice guidelines and a survey of clinicians.

Cross-sectional survey.

Members of the American Glaucoma Society (AGS).

We restated as an answerable clinical question each recommendation in the 2005 American Academy of Ophthalmology Preferred Practice Patterns (PPPs) regarding the management of POAG. We asked members of the AGS to rank the importance of each clinical question, on a scale of 0 (not important at all) to 10 (very important), using a 2-round Delphi survey conducted online between April and September 2008. Respondents had the option of selecting "no judgment" or "research has already answered this question" to each question in lieu of the 0 to 10 rating. We used the ratings assigned by the Delphi respondents to determine the importance of each clinical question.

Ranking of importance of each clinical question.

We derived 45 clinical questions from the POAG PPPs. Of the 620 AGS members invited to participate in the survey, 169 completed the Round 1 survey; 105 of 169 also completed Round 2. We observed 4 response patterns to the individual questions. Nine clinical questions were ranked as the most important: 4 questions on medical intervention, 4 questions on filtering surgery, and 1 question on adjustment of therapy.

Our theoretical model for priority setting for CER questions is a feasible and pragmatic approach that merits testing in other medical settings.