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I have found many citations that place systematic reviews at or near the top of the levels of evidence hierarchy, but discussions are limited to quantitative meta-analyses of RCTs. Are systematic reviews placed at the top of the evidence hierarchy because of their quantitative methodology, because the data they synthesize come from RCTs which are also at the top of the hierarchy, or both? Given that most of the medical research comprise studies other than RCTs, do citations exist that discuss where qualitative systematic reviews of quasi-experimental or observational studies fit into the hierarchy of evidence? Sincerely, Liz Adams Research Analyst, Technology Assessment Program VA Office of Patient Care Services Boston VA Healthcare System(11T) 150 S. Huntington Ave. Boston, MA Tel. (617) 278-4469 Fax (617) 278-4438 [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%