title: Assessing applicability when comparing medical interventions: AHRQ and the Effective Health Care Program.
abstract: OBJECTIVE
  To describe a systematic approach for identifying, reporting, and synthesizing information to allow consistent and transparent consideration of the applicability of the evidence in a systematic review according to the Population, Intervention, Comparator, Outcome, Setting domains.
  
  
  METHODS
  Comparative effectiveness reviews need to consider whether available evidence is applicable to specific clinical or policy questions to be useful to decision makers. Authors reviewed the literature and developed guidance for the Effective Health Care program.
  
  
  RESULTS
  Because applicability depends on the specific questions and needs of the users, it is difficult to devise a valid uniform scale for rating the overall applicability of individual studies or body of evidence. We recommend consulting stakeholders to identify the factors most relevant to applicability for their decisions. Applicability should be considered separately for benefits and harms. Observational studies can help determine whether trial populations and interventions are representative of "real world" practice. Reviewers should describe differences between available evidence and the ideally applicable evidence for the question being asked and offer a qualitative judgment about the importance and potential effect of those differences.
  
  
  CONCLUSIONS
  Careful consideration of applicability may improve the usefulness of systematic reviews in informing practice and policy.
authors.affiliation: Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development, Washington, DC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Atkins
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Chang
authors.forename: Gerald
authors.initials: G
authors.lastname: Gartlehner
authors.forename: David I
authors.initials: DI
authors.lastname: Buckley
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
authors.forename: Elise
authors.initials: E
authors.lastname: Berliner
authors.forename: David
authors.initials: D
authors.lastname: Matchar
mesh_terms: D000328:Adult; D000368:Aged; D057186:Comparative Effectiveness Research / Q000379:methods*; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006078:Government Programs; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011050:Policy Making; D012107:Research Design; D012196:Review Literature as Topic; D014481:United States; D016270:United States Agency for Healthcare Research and Quality