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RAMESES  January 2014

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Subject:

Re: Rapid Realist Review - thoughts

From:

Gill Westhorp <[log in to unmask]>

Reply-To:

Realist and Meta-narrative Evidence Synthesis: Evolving Standards" <[log in to unmask]>, Gill Westhorp <[log in to unmask]>

Date:

Sat, 25 Jan 2014 10:19:13 +1030

Content-Type:

text/plain

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text/plain (38 lines)

Hi Kev - and all

I beg to differ (slightly) from my more erudite friends.  I agree (of course) that there are many methods of review and that each is best suited to particular tasks.  

However, I believe that rapid realist reviews can be conducted on a variety of questions.  What makes them rapid is not the topic but the fact that a sufficiently refined and delimited question is asked, the boundaries that are put around the search process, and the safeguards that are put in place to keep the process both relevant (to the policy makers) and of sufficient quality (methodologically).  Keeping the claims made in keeping with the process used - i.e. don't claim a systematic review if you haven't done one - is of course also critical.  I assume you've seen Saul et al's article on RRR?

At essence, this refers back to 'what makes a review realist' - and in my view, that boils down to the nature of the analysis that is undertaken, not the breadth of the question or the comprehensiveness/systematic-ness of the search.  

The selection of review method does of course relate to 'fitness for purpose' as Andrew and Trish discuss.  For me, there are two things to work through in order to make the choice of method.  The first is - what do the policy makers actually want to DO with the product?  Policy makers don't just 'make policy' - they make specific kinds of decisions at different levels of policy abstraction and they need different kinds of information to inform different kinds of decisions.  The second is - given this specific purpose, what is/are the review question(s)?  Once you know the purpose and the question(s), you can select the appropriate method.

Kev - your second question below is much more suitable for a realist review (rapid or otherwise) than earlier versions.  I'd still play with the structure a little: (I've put the outcome and the target group together) - "How do configurations of managed care networks in dental care and their underlying mechanisms influence  best outcomes for vulnerable groups?" - and I'd beware the assumption that 'it's something about the configurations' that changes the mechanisms that generate the outcomes - but that's something you could theorise and investigate. 

Cheers
Gill 

-----Original Message-----
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Caoimhin Mac Giolla Phadraig
Sent: Saturday, 25 January 2014 7:30 AM
To: [log in to unmask]
Subject: Re: Rapid Realist Review - thoughts

Thanks for the quick response Trish,

The research question I posted earlier is the overall question of the project as a whole and differs from the specfic question at hand which I hope to answer through realist review. The realist review section asks: 

1.      How do we reorganize dental services to achieve changes that deliver best outcomes for vulnerable groups

or perhaps to make it more testable:

2.      How do configurations of managed care networks in dental care for vulnerable groups and their underlying mechanisms influence  best outcomes?

Andrew: your response is on the mark. I am only learning the utility of these tools and therefore the email. You suggest realist review to "shortlist" options for service development and then a Rapid RR to "fine tune" the selections. 

The problem I face is simple: policy decisions will be made within a short timeframe. They can be informed by some sort of review of the available evidence or not. I will look into the other formats that you propose - as your response suggests they may add more "Tools" to my toolbox. The more steer you guys can offer the better.

Thanks for the response 
Kev

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