Pearls, Pith, and Provocation Appraising the Evidence: Reviewing Disparate Data Systematically

The authors describe a method of systematically reviewing research from different para-digms. They draw on the methods adapted, developed, and designed during a study con-cerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encoun-tered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data and across disciplines. The move toward the use of evidence-based practice in health care decisionmaking has resulted in the increasing use of systematic reviews to make sense of rapidly expanding bodies of available research. More than 2 million articles are published annually in the biomedical literature in over 20,000 journals (Mulrow, 1994). As Chalmers and Altman (1995) have observed, “Reviews of the results of research have become essential for anyone who is trying to cope with the ever-increasing tidal waves of new research evidence ” (foreword). Those working in the field of Health Services Research (HSR), who necessarily cross the boundaries between medical sciences and social sciences, can face even larger mountains of evidence. The advantage of reviews of the literature is that they can summarize large amounts of research evidence. Increasingly, they are being used as a way of address-ing the rapid accumulation of health and social care information. New and faster ways of accessing the literature have facilitated this development. Both reviews and the results of primary research are now being used as bases for health care decisions