Excerpt

Effectiveness and Comparative Effectiveness Reviews, systematic reviews of existing research on the effectiveness, comparative effectiveness, and comparative harms of different medical tests, are intended to provide relevant evidence to inform real-world health care decisions for patients, providers, and policymakers. In an effort to improve the transparency, consistency, and scientific rigor of the work of the Effective Health Care (EHC) Program, the Agency for Healthcare Research and Quality (AHRQ), the Scientific Resource Center, and the Evidence-based Practice Centers (EPCs), have developed this Methods Guide for Medical Test Reviews (also referred to as the Medical Test Methods Guide). We intend it to serve as a resource for the EPCs as well as for other investigators interested in conducting systematic reviews on medical tests. We hope it will be a practical guide both for those who prepare the systematic reviews and those who use them in clinical practice, research development, and in making policy decisions.

Contents

• Preface
• AHRQ’s Evidence-Based Practice Centers
• The Effective Health Care Program
• List of Authors
• List of Peer Reviewers
• Editorial: Methods Guide for Authors of Systematic Reviews of Medical Tests: A Collaboration Between the Agency for Healthcare Research and Quality (AHRQ) and the Journal of General Internal Medicine
  Gerald W Smetana, MD; Craig A Umscheid, MD; Stephanie Chang, MD; David B Matchar, MD.
• 1. Introduction to the Methods Guide for Medical Test Reviews
  David B Matchar, MD, FACP, FAHA.
  • Introduction
  • Development of the Medical Test Methods Guide
  • Unique Challenges of Medical Tests
  • Recurrent Themes in the Test Evaluation Literature
  • Analytic Frameworks
  • A Note on Terminology
  • PICOTS Typology
  • Organization of This Medical Test Methods Guide
  • Summary
  • References
• 2. Developing the Topic and Structuring Systematic Reviews of Medical Tests: Utility of PICOTS, Analytic Frameworks, Decision Trees, and Other Frameworks
  David Samson, MS; Karen M Schoelles, MD, SM, FACP.
  • Introduction
  • Common Challenges
  • Principles for Addressing the Challenges
  • Illustrations
  • Summary
  • References
• 3. Choosing the Important Outcomes for a Systematic Review of a Medical Test
  Jodi B Segal, MD, MPH.
  • Introduction
  • Common Challenges
  • Principles for Addressing the Challenges and Recommended Approaches for Incorporating All Decision-Relevant Outcomes
  • Summary
  • References
• 4. Effective Search Strategies for Systematic Reviews of Medical Tests
  Rose Relevo, MLIS, MS.
  • Introduction
  • Common Challenges
  • Principles for Addressing the Challenges
  • Illustration: Contrasting Search Strategies
  • Summary
  • References
• 5. Assessing Risk of Bias as a Domain of Quality in Medical Test Studies
  P Lina Santaguida, BScPT, PhD, MSc; Crystal M Riley, MA; David B Matchar, MD.
  • Introduction
  • Evidence for Biases Affecting Medical Test Studies
  • Common Challenges
  • Principles for Addressing the Challenges
  • Illustration
  • Summary
  • References
• 6. Assessing Applicability of Medical Test Studies in Systematic Reviews
  Katherine E Hartmann, MD, PhD; David B Matchar, MD; Stephanie M Chang, MD, MPH.
  • Introduction
  • Common Challenges
  • Principles for Addressing the Challenges
  • An Illustration
  • Summary
  • References
• 7. Grading a Body of Evidence on Diagnostic Tests
  Sonal Singh, MD, MPH; Stephanie M Chang, MD, MPH; David B Matchar, MD; Eric B Bass, MD, MPH.
  • Introduction
  • Common Challenges
  • Principles for Addressing the Challenges
  • Illustration
  • Summary
  • References
• 8. Meta-Analysis of Test Performance When There Is a “Gold Standard”
  Thomas A Trikalinos, MD; Cynthia M Balion, PhD; Craig I Coleman, PharmD; Lauren Griffith, PhD; P Lina Santaguida, BScPT, PhD, MSc; Ben Vandermeer, MSc; Rongwei Fu, PhD.
  • Introduction
  • Nonindependence of Sensitivity and Specificity Across Studies and Why It Matters for Meta-Analysis
  • Principles for Addressing the Challenges
  • Recommended Approaches
  • A Workable Algorithm
  • Illustrations
  • Overall Recommendations
  • References
• 9. Options for Summarizing Medical Test Performance in the Absence of a “Gold Standard”
  Thomas A Trikalinos, MD; Cynthia M Balion, PhD.
  • Introduction
  • Imperfect Reference Standards
  • Options for Systematic Reviewers
  • Illustration
  • Summary
  • References
• 10. Deciding Whether To Complement a Systematic Review of Medical Tests With Decision Modeling
  Thomas A Trikalinos, MD; Shalini Kulasingam, PhD; William F Lawrence, MD, MS.
  • Introduction
  • A Workable Algorithm
  • Illustration
  • Overall Suggestions
  • References
• 11. Challenges in and Principles for Conducting Systematic Reviews of Genetic Tests Used as Predictive Indicators
  Daniel E Jonas, MD, MPH; Timothy J Wilt, MD, MPH; Brent C Taylor, PhD, MPH; Tania M Wilkins, MS; David B Matchar, MD.
  • Introduction
  • Common Challenges
  • Principles for Addressing the Challenges
  • Illustrations
  • Conclusions
  • References
• 12. Systematic Review of Prognostic Tests
  Thomas S Rector, PhD, Brent C Taylor, PhD, and Timothy J Wilt, MD, MPH.
  • Introduction
  • Step 1 Developing the Review Topic and Framework
  • Step 2 Searching for Studies
  • Step 3 Selecting Studies and Assessing Quality
  • Step 4 Extracting Statistics to Evaluate Test Performance
  • Step 5 Meta-Analysis of Estimates of Outcome Probabilities
  • Conclusion
  • References
• Appendix: Test Performance Metrics

Editorial Assistants: Rebecca Gray, D. Phil., Duke University; Marion M. Torchia, Ph.D., AHRQ

Prepared for: Center for Outcomes and Effectiveness, Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services¹.

Suggested citation:

Methods Guide for Medical Test Reviews. AHRQ Publication No. 12-EC017. Rockville, MD: Agency for Healthcare Research and Quality; June 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. Also published as a special supplement to the Journal of General Internal Medicine, July 2012.

This document was written with support from the Effective Health Care Program at the Agency for Healthcare Research and Quality (AHRQ). Its findings and conclusions are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this document should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the authors has any affiliations or financial involvements that conflict with the information presented in this chapter.

1

Rockville, MD 20850, www​.ahrq.gov