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

准确的诊断是提供适当卫生保健的基础。最近，越来越多的人认识到国民保健制度内诊断测试的重要性，并认识到有必要对诊断测试进行适当的评估。系统审查的目的是包括就某一特定专题进行的所有相关研究，并在考虑到质量和可靠性的情况下对其结果提供不偏不倚的总结。由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估，NICE发布了NHS内治疗和程序的使用指南。然而，与治疗审查相比，进行诊断测试审查的方法不那么成熟。拟议的方案旨在改善NHS在诊断测试领域的决策。我们的目标是通过一系列关于进行诊断审查的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导方针；(B)开发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NHS新的测试；(C)改进确定诊断研究的方法，并检查排除较难找到的研究对诊断审查结果的影响。(D)改进合并审评准确性数据的统计方法(E)制定适当报告诊断测试经济模型的准则，其中除纳入诊断性审评提供的准确性数据外，还纳入成本和效益数据；(F)调查向医生展示审评结果的最佳方式，以便在临床实践中作出适当改变。除了研究进行诊断性审查的方法外，我们还将对有可能改善NHS内测试使用的主题进行诊断性审查。总体而言，拟议方案旨在促进NHS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.