Reem A Mustafa1, Wojtek Wiercioch2, Ingrid Arevalo-Rodriguez3, Adrienne Cheung4, Barbara Prediger5, Liudmila Ivanova2, Matthew Ventresca2, Jan Brozek6, Nancy Santesso2, Patrick Bossuyt7, Amit X Garg8, Nancy Lloyd2, Monika Lelgemann9, Diedrich Bühler10, Holger J Schünemann11. 1. Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, Hamilton, Canada; Department of Internal Medicine, University of Kansas Medical Center, Kansas City, USA. 2. Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, Hamilton, Canada. 3. Fundación Universitaria de Ciencias de la Salud, Hospital San José & Hospital Infantil de San José, Bogotá, Colombia. 4. Faculty of Medicine, University of British Colombia, Vancouver, Canada. 5. Center for Medical Biometry and Medical Informatics, University of Freiburg, Freiburg im Breisgau, Germany. 6. Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada. 7. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands. 8. Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, Hamilton, Canada; Department of Medicine, Western University, London, Canada. 9. Medizinischer Dienst des Spitzenverbandes Bund der Kranken-kassen e.V. (MDS) Theodor Althoff-Str. 47, 45133 Essen, Germany. 10. Abteilung Medizin, GKV, Reinhardtstraße 28, 10117 Berlin, Germany. 11. Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada. Electronic address: schuneh@mcmaster.ca.
Abstract
OBJECTIVES: The objective of the study was to describe and compare current practices in developing guidelines about the use of healthcare-related tests and diagnostic strategies (HCTDS). STUDY DESIGN AND SETTING: We sampled 37 public health and clinical practice guidelines about HCTDS from various sources without language restrictions. RESULTS: Detailed descriptions of the systems used to assess the quality of evidence and develop recommendations were challenging to find within guidelines. We observed much variability among and within organizations with respect to how they develop recommendations about HCTDS. Twenty-four percent of the guidelines did not consider health benefits and harms but based decisions solely on test accuracy. We did not identify guidelines that described the main potential care pathways involving tests for a healthcare problem. In addition, we did not identify guidelines that systematically assessed, described, and referenced the evidence that linked test accuracy and patient-important outcomes. CONCLUSION: There is considerable variability among the processes used and factors considered in developing recommendations about the use of tests. This variability may be the cause for the disagreement we observed in recommendations about testing for the same condition.
OBJECTIVES: The objective of the study was to describe and compare current practices in developing guidelines about the use of healthcare-related tests and diagnostic strategies (HCTDS). STUDY DESIGN AND SETTING: We sampled 37 public health and clinical practice guidelines about HCTDS from various sources without language restrictions. RESULTS: Detailed descriptions of the systems used to assess the quality of evidence and develop recommendations were challenging to find within guidelines. We observed much variability among and within organizations with respect to how they develop recommendations about HCTDS. Twenty-four percent of the guidelines did not consider health benefits and harms but based decisions solely on test accuracy. We did not identify guidelines that described the main potential care pathways involving tests for a healthcare problem. In addition, we did not identify guidelines that systematically assessed, described, and referenced the evidence that linked test accuracy and patient-important outcomes. CONCLUSION: There is considerable variability among the processes used and factors considered in developing recommendations about the use of tests. This variability may be the cause for the disagreement we observed in recommendations about testing for the same condition.
Authors: Caroline Rick; Sue Mallett; James Brown; Ryan Ottridge; Andrew Palmer; Victoria Parker; Lee Priest; Jonathan J Deeks Journal: Trials Date: 2020-11-30 Impact factor: 2.279