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Evaluating Evidence on Intermediate Outcomes: Considerations for Groups Making Healthcare Recommendations
Daniel E Jonas1, Renée M Ferrari2, Roberta C Wines2
1Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, Chapel Hill, North Carolina.
American Journal of Preventive Medicine
|December 20, 2017
Summary
Assessing evidence linking intermediate outcomes (IOs) to health outcomes (HOs) is crucial for making recommendations on preventive services. This study outlines key considerations for evaluating the strength of the IO-HO link to improve evidence assessment.
Area of Science:
- Health Services Research
- Evidence-Based Practice
- Clinical Recommendations
Background:
- Recommendation-making bodies require evidence on preventive services' impact on health outcomes (HOs).
- When direct HO evidence is lacking, evaluating intermediate outcomes (IOs) and their link to HOs becomes necessary.
- This study addresses the need for clear considerations in assessing the evidence connecting IOs to HOs.
Purpose of the Study:
- To describe considerations for evaluating the evidence linking changes in intermediate outcomes (IOs) to changes in health outcomes (HOs).
- To inform recommendation-making groups on assessing the adequacy of IO-HO link evidence.
Main Methods:
- Developed working definitions for IOs, HOs, and other outcomes.
- Examined U.S. Preventive Services Task Force (USPSTF) recommendations (through April 2016) to identify methods and criteria for IO-HO link evidence.
- Reviewed methods of other expert and recommendation-making groups.
Main Results:
- Forty-four USPSTF recommendations involved an IO-HO link.
- Selected review (43%) and systematic review (27%) were common methods for gathering IO-HO link evidence.
- Key considerations for assessing IO-HO evidence include confounding adjustment, IO proximity to HO in the causal pathway, and independence from specific treatments.
Conclusions:
- Identified considerations for recommendation-making groups in gathering and assessing IO-HO link evidence.
- Standardized written principles can enhance transparency in IO-HO link assessments.
- The ideal process would estimate the magnitude of HO changes expected from specified IO changes.
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