Making diagnostic systematic reviews fit for purpose: improving decision making in the NHS

准确的诊断是提供适当保健的基础。最近越来越多的人认识到诊断测试在国民保健制度中的重要性，以及对诊断测试进行适当评价的必要性。系统性综述旨在包括针对特定主题进行的所有相关研究，并在考虑质量和可靠性的情况下对其结果进行公正的总结。国家健康和临床卓越研究所（NICE）提出的建议主要基于系统评价，该研究所发布了关于在NHS内使用治疗和程序的指南。然而，与治疗审查相比，诊断测试审查的方法还没有得到很好的确立，拟议的方案旨在改善国民保健制度在诊断测试领域的决策。我们的目标是通过一系列关于诊断审查方法的项目来做到这一点，这些项目将：（A）审查现有审查的质量，并以此为基础制定报告诊断审查的指南;（B）制定一种方法来确定系统审查的重要候选测试，例如那些昂贵的、经常使用的或对NHS来说是新的测试;（C）改进确定诊断性研究的方法，并审查排除较难找到的研究对诊断性审查结果的影响。(D)改进统计方法，以便在审查中结合准确性数据;（E）制定诊断测试经济模型的适当报告指南，其中包括成本和收益数据以及诊断审查提供的准确性数据;（F）调查向医生提供审查结果的最佳方式，以便导致临床实践的适当变化。除了开展诊断审查方法的工作外，我们还将对有可能改善NHS内测试使用的主题进行诊断审查。总体而言，拟议方案旨在促进国民保健制度内有效和适当地使用诊断测试。

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.