The goal of this project, in response to AHCPR RFA:HS-92-03, is to improve the outcomes of pharmaceutical therapies in ambulatory settings by providing opinion leaders and thus practicing physicians with up-to- date pooled results from meta-analyses (M-As) of randomized controlled trials (RCTs) of drug comparisons using our recently developed methods, cumulative meta-analysis (CMA), and creating a Real-Time Meta- Analysis System to facilitate experts knowledge base and facilitate the prompt recognition of effective and the appropriate use of ambulatory pharmaceutical therapies. Three clinical areas have been chosen that: 1) afflict large numbers of the population; 2) disorders for which a large number of RCTs or alternative pharmaceuticals are available; 3) where alternative therapies have wide ranging cost implications; and 4) those not currently being evaluated in AHCPR PORT projects. These three areas are: antibiotic usage, hypertension, and congestive heart failure. Specifically, our aims are to: 1) to develop the RTMAS, by applying the techniques of CMA and a matrical method of organizing RCT data and M-A results; 2) to develop comprehensive databases of RCTs in the three clinical areas and perform CMAs of RCTs to determine the efficacy of ambulatory pharmaceuticals; 3) to dissemination RCT databases and M-A results to opinion leaders, practicing physicians, and researchers; 4) to test the hypothesis that opinion leaders are as inconsistent and lagging in response to published RCTs in the ambulatory field as they are in the inpatient setting; and 5) to assess the impact of M-As on opinion leader recommendations. Over a four-year period, the following tasks will be done to accomplish these aims: 1) develop a computer-based RTMAS to organize, routinely update and display RCTs and M-As of ambulatory pharmaceuticals in the clinical areas in an efficient, easy-to-use, and easy-to-understand matrix format;2) develop and maintain up-to-date databases of RCTs and M-As in the following clinical mentioned above; 3) update previously published M-As and applying CMAs to determine the efficacy and outcomes of the ambulatory use of the above pharmaceutical therapies; 4) disseminate M-As by publication in appropriate journals and to opinion leaders; 5) monitor opinion leader recommendations published in journal review articles and textbook chapters and comparing their recommendations with CMAs; 6) study the impact of published M-As on opinion leader recommendations by performing citation-analyses.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS007782-01
Application #
3373131
Study Section
Special Emphasis Panel (SRC)
Project Start
1993-03-01
Project End
1996-02-29
Budget Start
1993-03-01
Budget End
1994-02-28
Support Year
1
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Tufts University
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02111
de Ferranti, S D; Ioannidis, J P; Lau, J et al. (1998) Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis. BMJ 317:632-7
Bonis, P A; Ioannidis, J P; Cappelleri, J C et al. (1997) Correlation of biochemical response to interferon alfa with histological improvement in hepatitis C: a meta-analysis of diagnostic test characteristics. Hepatology 26:1035-44
Ioannidis, J P; Lau, J (1997) The impact of high-risk patients on the results of clinical trials. J Clin Epidemiol 50:1089-98
Lau, J; Ioannidis, J P; Schmid, C H (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820-6
Ioannidis, J P; Cappelleri, J C; Sacks, H S et al. (1997) The relationship between study design, results, and reporting of randomized clinical trials of HIV infection. Control Clin Trials 18:431-44
Ioannidis, J P; Cappelleri, J C; Schmid, C H et al. (1996) Impact of epidemic and individual heterogeneity on the population distribution of disease progression rates. An example from patient populations in trials of human immunodeficiency virus infection. Am J Epidemiol 144:1074-85
Cappelleri, J C; Ioannidis, J P; Schmid, C H et al. (1996) Large trials vs meta-analysis of smaller trials: how do their results compare? JAMA 276:1332-8
Ioannidis, J P; Cappelleri, J C; Skolnik, P R et al. (1996) A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Arch Intern Med 156:177-88
Ioannidis, J P; Cappelleri, J C; Lau, J et al. (1995) Early or deferred zidovudine therapy in HIV-infected patients without an AIDS-defining illness. Ann Intern Med 122:856-66