Marian McDonagh, Pharm.D., is professor of medical informatics and clinical epidemiology, OHSU School of Medicine.

December 7, 2015

What’s been the most interesting development in your area in the last two years?

My area of research is evidence review and synthesis – mainly through the use of systematic review methodology. There have been continuing advancements in various areas of evidence review work, including recognizing problems with reporting bias and statistical methods (e.g. network meta-analysis). However, I’d say the biggest and potentially most important development has been the establishment of what are called “Rapid Reviews” as an emerging methodology for dealing with decision-making evidence needs in what might be described as “real-time.” We are in the very early stages of developing both a taxonomy and methodology around such reviews – there is wide variation in what people are doing and the type of evidence required by decision-makers. Rapid reviews use pieces of systematic review methodology to provide summaries of evidence on narrowly defined topics, and we need to evaluate what particular methods are required or could be modified to achieve these goals in very efficient manner.

What projects are you currently working on and are there opportunities for fellow faculty to participate?

For the past 12 years, I have been the PI for the evidence review work our Evidence-based Practice Center has done for the Drug Effectiveness Review Project (DERP), a collaboration of state Medicaid Agencies that collectively commission comparative systematic reviews of drug therapies used by the agencies to assist in developing evidence-based policies regarding use of prescription drugs in their programs. We are currently working on reviews of the direct-acting oral anticoagulant drugs, drugs for multiple sclerosis, targeted immune modulators and drugs for asthma and COPD. In the coming year, topics will include antipsychotic drugs, antidepressants, oral oncology drugs, drugs for opioid dependence, drugs for diabetes, hepatitis C and pulmonary arterial hypertension. We are always interested in collaborations with clinician researchers and have had many successful experiences with clinical faculty in the past.

A hypothetical: If you could have one tool that would solve a seemingly impenetrable problem in your work, what would it do? You have unlimited resources to design this tool, so think big.

Systematic reviews are very labor-intensive exercises, and  we are now in an era where there is strong tension between comprehensive review methods and Rapid Review processes. Each has advantages and disadvantages. The in-depth evaluation of the evidence is largely lost in the rapid processes, but the quick turnaround of a rapid process fits real-life circumstances better.  Therefore, there is a strong need for methods (tools) to greatly improve the efficiency of our processes. I have been working with my colleague Aaron Cohen, MD, MPH, on methods to use informatics to improve the efficiency in parts of our processes, but these methods are still in their infancy. We need an advanced, comprehensive set of tools that have been tested for validity and reliability and shown to improve efficiency but that maintain quality. If we had such tools, we would be able to achieve equivalent results more rapidly and with less cost.

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