Non-experimental study, qualitative study, or meta-synthesis. Level IV Opinion of nationally recognized experts based on research evidence or expert

Expert Opinion expertise

consensus panel (systematic review, clinical practice guidelines) Level V Opinion of individual expert based on non-research evidence. (Includes case

studies; literature review; organizational experience e.g., quality improvement and financial data; clinical expertise, or personal experience)

QQUUAALLIITTYY of the Evidence

A High

Research consistent results with sufficient sample size, adequate control, and definitive conclusions; consistent recommendations based on extensive literature review that includes thoughtful reference to scientific evidence.

Summative reviews

well-defined, reproducible search strategies; consistent results with sufficient numbers of well defined studies; criteria-based evaluation of overall scientific strength and quality of included studies; definitive conclusions.

Organizational well-defined methods using a rigorous approach; consistent results with sufficient sample size; use of reliable and valid measures

Expert Opinion expertise is clearly evident B Good Research reasonably consistent results, sufficient sample size, some control, with fairly definitive conclusions;

reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence

Summative reviews

reasonably thorough and appropriate search; reasonably consistent results with sufficient numbers of well defined studies; evaluation of strengths and limitations of included studies; fairly definitive conclusions.

Organizational Well-defined methods; reasonably consistent results with sufficient numbers; use of reliable and valid measures; reasonably consistent recommendations

Expert Opinion expertise appears to be credible. C Low quality

or major flaws

Research little evidence with inconsistent results, insufficient sample size, conclusions cannot be drawn Summative reviews

undefined, poorly defined, or limited search strategies; insufficient evidence with inconsistent results; conclusions cannot be drawn

Organizational Undefined, or poorly defined methods; insufficient sample size; inconsistent results; undefined, poorly defined or measures that lack adequate reliability or validity

Expert Opinion expertise is not discernable or is dubious. *A study rated an A would be of high quality, whereas, a study rated a C would have major flaws that raise serious questions about the believability of the findings and should be automatically eliminated from consideration