The Research Agenda-Setting Project (RASP)

David Steven Friedman and Andrew G. Lee

In 2001, the John A. Hartford Foundation and the American Geriatrics Society set out to publish in a book format a research agenda-setting process (RASP) to achieve the following goals: (1) to increase research activity in the field of geriatrics within specific surgical and related medical specialties; (2) to attract new specialty researchers to study and subsequently meet the unique needs and requirements of the older patient in these specific surgical and related medical specialties; (3) to increase the number and quality of age-related research grant applications (e.g., National Institutes of Health, the Department of Veterans Affairs, and other agencies); and (4) to improve the well-being of older patients in specialty care. The process involved the selection of faculty members from each specialty to serve as content experts and writers and to review and eventually to update the present status of research on the geriatrics aspects within their respective specialties. For ophthalmology, these authors were Anne Coleman, MD and Andrew Lee, MD. The content experts met at the RAND Corporation in Santa Monica, California in February of 2001 to receive systematic instructions on ‘‘how to conduct a systematic literature review’’; ‘‘how to classify research by type of study design’’; and ‘‘how to develop preliminary search strategies.’’ The searches were coordinated by professional RAND librarians and an iterative process followed with contribution from the senior writers, the content experts, and the librarians. The group revised their search strategies and individually reviewed selected titles, abstracts, and eventually specific full papers. The content experts were at liberty to expand the searches independently but in all cases the reference lists were searched for additional relevant earlier publications. The literature reviews were conducted using an English-language search, limited to human subjects of MEDLINE (through PubMed or DIALOG). The search terms were for ‘‘65 or older’’ or ‘‘aged’’ or ‘‘geriatric,’’ followed by a list of content topics of importance in each specialty. The earliest year searched varied (1980–1994) and the latest year was the first half of 2001. A research consultant maintained a full list of titles from each

D.S. Friedman (*)

Johns Hopkins University, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore,

MD, USA

literature search in an EndNote database and the project director and the research consultant reviewed the titles and abstracts (where necessary) for relevance to the cross-cutting issues section. The research consultant also obtained full-text copies of the papers; forwarded these papers to the Senior Writing Group; added new references as needed to the EndNote database; and verified the accuracy of the final list of citations.

The first drafts were reviewed by the editors, and additional revisions were made and finalized at a face-to-face conference in Potomac, MD, in November 2001 cosponsored by the Agency for Healthcare Research and Quality (AHRQ). The RASP is the final product of this effort. Ophthalmology is proud to have participated in the RASP.

Each RASP chapter includes the following: (1) key elements of the literature review for that specialty or for the cross-cutting issues; (2) a complete reference section at the end of each chapter; (3) individual sections ending with the pertinent research agenda setting items with a unique section identifying number to facilitate cross-referencing and citation; (4) discussion of the issues of most concern in the care of older patients by practitioners in the specific discipline; (5) key research questions with the highest priority in the opinion of the experts participating in the project; and (6) examples of hypothesisgenerating and hypothesis-testing research needed to address each key question. Each of the agenda items in each section was labeled with a letter from A to D (designating the type of research design and the clinical priority or importance of the proposed study). In the RASP, the word level was not intended to imply degrees of quality and was defined instead as follows:

Level A identifies important studies with hypothesis-testing intent, using such designs as randomized controlled trials, certain nonrandomized controlled trials, or those cohort studies that focus on a single hypothesis.

Level B identifies important studies with hypothesis-generating intent. Designs would include exploratory, multitargeted cohort and case–control studies; retrospective or prospective analysis of large databases; crosssectional observational studies; time series; outcome studies; retrospective case series; or post hoc analyses of randomized controlled trials.

Level C identifies hypothesis-testing studies judged by the content experts to be of lesser importance and priority than those labeled A.

Level D identifies hypothesis-generating studies judged to be of lesser importance than studies labeled B.

In the RASP, the proposed A (or C) studies generally must be preceded by B (or D respectively). Although A studies in general would rank higher in terms of the quality of the evidence they would provide, B studies often have sequence priority over A studies because of cost, logistical, and ethical issues surrounding designing and implementing an ‘‘A’’ study. All of the elements in the RASP book are indexed by topic with discussions of the literature in all the specialty fields and for each cross-cutting issue, specific studies by name, tables and figures, the agenda items and key questions, descriptions of research design, as well as the