title: The refinement of topics for systematic reviews: lessons and recommendations from the Effective Health Care Program.
abstract: OBJECTIVE
  The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program conducts systematic reviews of health-care topics nominated by stakeholders. Topics undergo refinement to ensure relevant questions of appropriate scope and useful reviews. Input from key informants, experts, and a literature scan informs changes in the nominated topic. AHRQ convened a work group to assess approaches and develop recommendations for topic refinement.
  
  
  METHODS
  Work group members experienced in topic refinement generated a list of questions and guiding principles relevant to the refinement process. They discussed each issue and reached agreement on recommendations.
  
  
  RESULTS
  Topics should address important health-care questions or dilemmas, consider stakeholder priorities and values, reflect the state of the science, and be consistent with systematic review research methods. Guiding principles of topic refinement are fidelity to the nomination, relevance, research feasibility, responsiveness to stakeholder inputs, reduced investigator bias, transparency, and suitable scope. Suggestions for stakeholder engagement, synthesis of input, and reporting are discussed. Refinement decisions require judgment and balancing guiding principles. Variability in topics precludes a prescriptive approach.
  
  
  CONCLUSIONS
  Accurate, rigorous, and useful systematic reviews require well-refined topics. These guiding principles and methodological recommendations may help investigators refine topics for reviews.
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: FM, Portland, OR 97239, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Buckley
authors.affiliation: Clinical Epidemiology Program, Methods Centre, Box 201B, General Campus, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Ansari
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Butler
authors.affiliation: Kaiser Permanente Center for Health Research, Evidence-based Practice Center, 3800 N Interstate Ave, Portland, OR 97227, USA.
authors.forename: Clara
authors.initials: C
authors.lastname: Soh
authors.affiliation: Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Chang
mesh_terms: D057186:Comparative Effectiveness Research / Q000379:methods* / Q000592:standards; D003657:Decision Making; D019317:Evidence-Based Medicine; D017063:Outcome Assessment, Health Care / Q000379:methods; D012107:Research Design; D012196:Review Literature as Topic
keywords: Decision making; Evidence-based practice; Methods; Patient-centered care; Research design; Stakeholder engagement; Systematic review