Feasibility of Using Qualitative Analysis for Systematic Reviews of Complex Inter

描述(由申请人提供)：本研究的目标是确定在复杂卫生干预措施的系统评价中使用定性比较分析(QCA)的可行性，以通过确定与有效性相关的关键干预特征来丰富评价结果。系统评价是循证卫生保健的基础，是临床指南、质量措施和卫生政策的基础。然而，对复杂干预措施的审查是具有挑战性的，因为在纳入的研究中经常存在很大程度的临床和方法异质性。审查调查人员需要新的方法来补充现有的复杂干预审查方法。我们期待QCA被用于分析研究水平的协变量，以更好地探索异质性，并可能提供比现有方法的优势，因为它最初是一种研究复杂现象的方法。QCA是一种基于集合论因果关系(即，自变量和因变量之间的集合、超集和子集)的面向案例的非概率技术。它共享定量和定性方法的特点，并通过使用布尔代数的逻辑最小化过程产生结果。我们将把QCA应用于已经完成的医疗研究机构和由质量资助的干预措施的比较有效性审查，以改善用药依从性。这篇综述例证了一项复杂的干预综述，因为它包括多个干预目标和制剂、截然不同的干预成分以及干预持续时间和强度的差异的研究。这项拟议的研究是QCA在系统评价中的第一次这样的应用。具体目的是(1)使用QCA来确定哪些干预功能单独或联合使用与改善慢性病长期药物治疗的门诊患者的服药依从性有关，以及(2)描述我们在系统审查干预措施以提高服药依从性的背景下应用QCA的过程。我们将把药物依从性审查中纳入的每个研究作为一个分析单元，并将使用QCA来评估研究协变量与治疗效果的关系。在这种情况下，我们将用集合论的必要性和充分性陈述来表达我们的发现。例如，“改善服药依从性的复杂健康干预措施需要成分X和成分A或D，或B和C的组合。”我们期望这项工作将在系统审查的背景下确定使用QCA的初步可行性。如果可行，QCA将显著改进复杂干预措施的审查方法，因为它除了利用复杂健康干预审查中现有的异质性外，还应用了一种根本不同的范式(使用集合关系)来评估因果关系。

DESCRIPTION (provided by applicant): The objective of this study is to determine the feasibility of using qualitative comparative analysis (QCA) within systematic reviews of complex health interventions to enrich review results through identification of key intervention features associated with effectiveness. Systematic reviews are the foundation for evidence- based health care, and form the basis for clinical guidelines, quality measures, and health policy. However, reviews of complex interventions are challenging because of the large degree of clinical and methodological heterogeneity that is often present among included studies. Review investigators need new methods to complement existing methods of review for complex interventions. We expect QCA to be used to analyze study-level covariates to better explore heterogeneity, and may offer an advantage over existing methods because of its origins as a method to study complex phenomena. QCA is a case-oriented, nonprobabilistic technique based on set-theoretic causal relationships (i.e., set, superset, and subset) between independent and dependent variables. It shares features of both quantitative and qualitative methods and produces results through a process of logical minimization using Boolean algebra. We will apply QCA to an already completed Agency for Healthcare Research and Quality-funded comparative effectiveness review of interventions to improve medication adherence. This review exemplifies a complex intervention review because it included studies with multiple intervention targets and agents, vastly different intervention components, and differences in duration and intensity of intervention. The proposed study is the first such application of QCA to systematic reviews. The specific aims are to (1) use QCA to determine which intervention features alone or in combination are related to improved medication adherence among outpatients who are prescribed long-term medication therapy for chronic conditions, and (2) describe our process for applying QCA within the context of the systematic review of interventions to increase medication adherence. We will treat each included study within the medication adherence review as a unit of analysis and will use QCA to evaluate study covariates for their relationship to the treatment effect. In this context, we would express our findings in set-theoretic statements of necessity and sufficiency. For example, "Complex health interventions to improve medication adherence require component X and either component A or D, or the combination of B and C." We expect that this work will determine the initial feasibility f using QCA within a systematic review context. If feasible, QCA will significantly enhance review methods for complex interventions because it applies a fundamentally different paradigm (the use of set relationships) for evaluating causal relationships in addition to taking advantage of existing heterogeneity within complex health intervention reviews.