ABSTRACT
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ABSTRACT A goal of comparative effectiveness research is to help stakeholders reach consensus about the benefits and harms of medical interventions, at both the individual and population levels. The Institute of Medicine and others have recognized that to advance comparative effectiveness research, it will be necessary to use evidence from data sources other
than randomized-controlled clinical trials. Different sources of evidence, such as randomized trials, observational studies, and meta-analyses, however, have strengths and weaknesses. Therefore, to help stakeholders reach consensus about the effectiveness of medical interventions, we argue it will be necessary not only to generate, but also to synthesize and weigh evidence from multiple data sources. In this chapter, we illustrate and refine an approach for using information from multiple data sources called crossdesign synthesis. Cross-design synthesis is a way of thinking about and framing comparative effectiveness questions such that multiple data sources can be used together to help answer those questions. We briefly review the strengths and weaknesses of evidence generated from different study designs, introduce cross-design synthesis, and illustrate the use of crossdesign synthesis with a case study investigating whether the initiation of the use of antidepressants increases the risk of suicidal behavior in depressed children and adolescents.
