Making diagnostic systematic reviews fit for purpose: improving decision making in the NHS
Lead Research Organisation:
University of Bristol
Department Name: Social Medicine
Abstract
Accurate diagnosis is fundamental to the provision of appropriate health care. There has recently been increased recognition of the importance of diagnostic testing within the NHS and the need for appropriate evaluation of diagnostic tests. Systematic reviews aim to include all relevant studies conducted on a particular topic and to provide an unbiased summary of their results taking into account both quality and reliability. Recommendations made by the National Institute for Health and Clinical Excellence (NICE), who issue guidance on the use of treatments and procedures within the NHS, are based largely on systematic reviews. However, methods for the conduct of reviews of diagnostic tests are less well established than for reviews of treatments.
The proposed programme aims to improve decision-making in the NHS in the area of diagnostic testing. We aim to do this through a series of projects on methods for the conduct for diagnostic reviews that will: (A) review the quality of existing reviews and use this as a basis to develop guidelines for reporting diagnostic reviews; (B) Develop a method to identify tests that are important candidates for systematic reviews, for example those that are costly, frequently used, or new to the NHS; (C) Improve methods for the identification of diagnostic studies and examine the impact of excluding studies that are harder to find on the results of diagnostic reviews. (D) Improve statistical methods for combining data on accuracy within reviews (E) Develop guidelines for the appropriate reporting of economic models of diagnostic tests that incorporate data on costs and benefits in addition to data on accuracy provided by diagnostic reviews; (F) Investigate the best ways to present results of a review to doctors, so that lead to appropriate changes in clinical practice. In addition to work on methods for the conduct of diagnostic reviews, we will also carry out diagnostic reviews on topics that have potential to improve test use within the NHS. Overall, the proposed programme aims to facilitate the efficient and appropriate use of diagnostic tests within the NHS.
The proposed programme aims to improve decision-making in the NHS in the area of diagnostic testing. We aim to do this through a series of projects on methods for the conduct for diagnostic reviews that will: (A) review the quality of existing reviews and use this as a basis to develop guidelines for reporting diagnostic reviews; (B) Develop a method to identify tests that are important candidates for systematic reviews, for example those that are costly, frequently used, or new to the NHS; (C) Improve methods for the identification of diagnostic studies and examine the impact of excluding studies that are harder to find on the results of diagnostic reviews. (D) Improve statistical methods for combining data on accuracy within reviews (E) Develop guidelines for the appropriate reporting of economic models of diagnostic tests that incorporate data on costs and benefits in addition to data on accuracy provided by diagnostic reviews; (F) Investigate the best ways to present results of a review to doctors, so that lead to appropriate changes in clinical practice. In addition to work on methods for the conduct of diagnostic reviews, we will also carry out diagnostic reviews on topics that have potential to improve test use within the NHS. Overall, the proposed programme aims to facilitate the efficient and appropriate use of diagnostic tests within the NHS.
Technical Summary
Accurate diagnosis is fundamental to the provision of appropriate health care. A recent BMJ editorial highlighted the need for a more ?formal and systematic process for the evaluation and oversight of laboratory diagnostic tests?. Systematic reviews underpin the work of NICE in guiding NHS practice, but methods for diagnostic reviews are less well established than those for reviews of intervention studies.
Based on funding from NIHR and MRC, the applicants? previous work has focussed on methods for diagnostic systematic reviews as well as the conduct of such reviews. Major achievements include work on quality assessment, statistical methodology for diagnostic meta-analyses, work on economic evaluation and substantive reviews incorporating methodological innovations.
The proposed programme aims to improve decision-making in the NHS in the area of diagnostic testing by addressing the following objectives: (A) Review the quality of existing diagnostic reviews and develop guidelines for reporting such reviews; (B) Develop a methodology using routine data to identify high volume, rapidly emerging, diagnostic tests appropriate for systematic review; (C) Develop methodology for electronic literature searches, including developing an improved filter, investigating whether citation scanning improves the efficiency of literature searches and determining the impact of hard-to-locate studies on review results; (D) Develop methodology for meta-analysis of diagnostic reviews, focussing on whether individual patient data (IPD) meta-analyses can improve on current practice based on meta-analysis of data summarised in 2‘2 tables and using IPD to develop assess the added value of a test; (E) Produce a parsimonious checklist to guide appropriate reporting of cost-effectiveness models; (F) Investigate review results can influence clinical practice, by reviewing relevant primary studies, investigating how presentation of review results can affect engagement with review findings and comparing test ordering practice before and after the publication of a systematic review or guidelines. Such methodological work requires that we are active in conducting diagnostic reviews. With our clinical collaborators, we plan to undertake two such reviews: (1) serum markers in children undergoing chemotherapy and (2) D-dimer for the diagnosis of DVT in primary care. We will work with a range of collaborators, including the Cochrane Depression, Anxiety and Neurosis group.
Evidence-based diagnostic practice, underpinned by high quality systematic reviews, is essential for the efficient use of diagnostic tests within the NHS. The proposed programme aims to make important contributions to the field of diagnostic evaluation, and in particular the methodology of diagnostic reviews.
Based on funding from NIHR and MRC, the applicants? previous work has focussed on methods for diagnostic systematic reviews as well as the conduct of such reviews. Major achievements include work on quality assessment, statistical methodology for diagnostic meta-analyses, work on economic evaluation and substantive reviews incorporating methodological innovations.
The proposed programme aims to improve decision-making in the NHS in the area of diagnostic testing by addressing the following objectives: (A) Review the quality of existing diagnostic reviews and develop guidelines for reporting such reviews; (B) Develop a methodology using routine data to identify high volume, rapidly emerging, diagnostic tests appropriate for systematic review; (C) Develop methodology for electronic literature searches, including developing an improved filter, investigating whether citation scanning improves the efficiency of literature searches and determining the impact of hard-to-locate studies on review results; (D) Develop methodology for meta-analysis of diagnostic reviews, focussing on whether individual patient data (IPD) meta-analyses can improve on current practice based on meta-analysis of data summarised in 2‘2 tables and using IPD to develop assess the added value of a test; (E) Produce a parsimonious checklist to guide appropriate reporting of cost-effectiveness models; (F) Investigate review results can influence clinical practice, by reviewing relevant primary studies, investigating how presentation of review results can affect engagement with review findings and comparing test ordering practice before and after the publication of a systematic review or guidelines. Such methodological work requires that we are active in conducting diagnostic reviews. With our clinical collaborators, we plan to undertake two such reviews: (1) serum markers in children undergoing chemotherapy and (2) D-dimer for the diagnosis of DVT in primary care. We will work with a range of collaborators, including the Cochrane Depression, Anxiety and Neurosis group.
Evidence-based diagnostic practice, underpinned by high quality systematic reviews, is essential for the efficient use of diagnostic tests within the NHS. The proposed programme aims to make important contributions to the field of diagnostic evaluation, and in particular the methodology of diagnostic reviews.
