David Tovey, Ruth foxlee and sera tort

Prioritisation workshop: how can we meet the Strategy to 2020 target and what does it mean for individual review groups? DAVID TOVEY, RUTH FOXLEE AND SERA TORT

Workshop aims:

Describe target and approach taken so far Share responses from internal groups Share published information from external organisations Discussion on how groups can use the various sources and

data Discussion on what this means for the Strategy 2020 target.

Workshop plan Welcome and introductions

Presentation What does the target say? What are we planning? What have we done?

Discussion How can we build on what has been done? What can we learn? How can we maximise the usefulness of the work? Next steps?

Target 1.1: General description Develop a list of approximately 200 new high-priority and ‘to-update’ Cochrane Systematic Reviews that will direct production priorities; and establish a decision-making framework that will enable the priority list to be updated at regular intervals.

Target 1.1: Indicators of success:

Cochrane groups and the Central Executive team have engaged with a cross-section of users (including patients and other healthcare consumers, health practitioners, policy-makers, guidelines developers and existing and potential research funders) to identify questions that are most relevant and important to them.

A list of approximately 200 new high-priority and ‘to-update’ Cochrane Systematic Reviews that will direct organisation-wide production priorities for 2015 onwards has been developed.

100 new reviews from the list have been commissioned (review author teams identified and titles registered).

A priority-setting decision-making framework for Cochrane Systematic Reviews is in place.

Target 1.1: Timing List and decision-making framework completed by end of

December 2014.

Commissioning of 100 new reviews from the list completed by July 2015.

Initial plan Internal work

Support from CRGs and Fields Updating decisions

Data gathering: access / citations Tools

External work Prioritisation and Agenda Setting Methods Group project Data gathering: published research priorities Meetings with selected external organisations Burden of disease work

Internal groups Initial request from CRGs and Fields for recent or current work on priority setting:

The evidence for it being a priority

At least one user group for which this is a priority

The source of the priority e.g. funder, data analysis etc. and, if appropriate, the process involved

The research question/review title(s) you have identified.

UpdatingAccess and citation data

Email CRGs: highest 20 cited Individual CRG reports

Decision tools 3 tools

Tool 1: prioritisation criteria

Tools 2 & 3: Qualitative and quantitative decision tools

Step 1: Is the clinical question answered or no longer relevant?

Step 2: Are there any new factors to consider?

Steps 3 & 4: Are there new studies? Are the conclusions likely to change?

Tool 3: Statistical prediction tool

About metarank Based on minimal information on the new evidence

assumes an update strategy is in place such that number of new studies and their sample sizes are known

‘Signals’ of the need to update implemented as a STATA user-written function

Performs simulation of several meta-analyses, each with one or more new studies of different sizes

The decision tool provides a set of criteria that can be used to assess whether to update a Cochrane Review.

The tool can be applied to a single Cochrane Review or can be used to prioritise a suite of reviews (e.g. those from an individual Cochrane Review Group)

Decision tool: summary

External sources of data

Sources – countries & organisations

Australia AusAID, National Health and Medical Research Council (NHMRC) & Pharmaceutical Benefits Scheme (PBS)

Canada Canadian Institutes of Health Research (CIHR)

Saudi Arabia Ministry of Health

UK Evidence Aid, James Lind Alliance, Medical Research Council (MRC), NICE Guidelines, NICE Research

Recommendations Database, Scottish Intercollegiate Guideline Network (SIGN), Welcome Trust

USA Agency for Health Research Quality (AHRQ), Patient-Centered Outcomes Research (PCORI), USAID

International WHO Essential Medicine List, World Heart Federation

Sources – Spain

Instituto de Salud Carlos III (ISCII)

CIBER-BBN. Biomedical Research Networking Centre In Bioengineering, Biomaterials & Nanomedicine

CIBERDEM. Network Biomedical Research Centre in Diabetes and Associated Metabolic Disorders

CIBEREHD. Network Biomedical Research Centre in Hepatic & Digestive Diseases

CIBERER. Network Biomedical Research Centre in Rare Diseases

CIBERES. Network Biomedical Research Centre in Respiratory Diseases

CIBERESP. Network Biomedical Research Centre in Epidemiology & Public Health

CIBEROBN. Network Biomedical Research Centre Obesity & Nutrition

CIBERSAM. Network Biomedical Research Centre in Mental Health

Centro Superior de Investigaciones Científicas. The Spanish National Research Council (CSIC)

GuiaSalud (Guidelines) Health Technology Agencies

Top 10 priority areas by CRG

Public Health

Heart

Effective Practice & Organisation of Care

Pregnancy & Childbirth

Musculoskeletal

Airways

Developmental, Psychosocial & Learning Problems

Depression, Anxiety & Neurosis

Metabolic & Endocrine Disorders

Drugs & Alcohol

Top research priorities by browse topic

Public Health

Heart & circulation

Cancer

Mental health

Lung & airways

Neurology

Pregnancy & Childbirth

Effective practice/health systems

Infectious Disease

Developmental, Psychosocial & Learning Problems

Endocrine & metabolic

Orthopaedics & trauma

Tobacco, Drugs & Alcohol

Country Organisation Specific topic area CEU/CLib topic area

CRG

Australia NHMRC Asthma Lung & airways Airways

Australia Pharmaceutical Benefits Scheme (PBS)

Is there any new evidence on the effi cacy and safety of single ingredient inhaled corticosteroid vs. fixed dose combination (FDC) inhaled long-acting beta-agonists and inhaled corticosteroids?

Lung & airways Airways

Canada Canadian Institutesof Health Research (CIHR)

Growing prevalence and burden of chronic diseases, including mental illness and neurodegenerative diseases, in an aging population: heart disease, cancer, diabetes, obesity, asthma, allergy and arthritis, as well as mental illness, addiction and substance abuse


Spain CIBERES CIBERES has implemented the following 9 CRPs that include 32 research lines and 97 active research projects: Asthma, Sleep Apnea, Lung Cancer, COPD, Pulmonary Fibrosis, Acute Lung Injury, Pneumonia, Pathogen - Host interactions, Tuberculosis


Spain GuiaSalud (Guidelines)

In development: Asthma update Lung & airways Airways

UK James Lind Alliance

Asthma priority setting partnership top 10: 1a. What are the adverse effects associated with long term use of short and long actingbronchodilators; inhaled and oral steroids; and combination and additive therapies in adults? (N.B this includes children aged 12 years old and over) 1b. What are the adverse effects associated with long term use of short and long acting bronchodilators; inhaled and oral steroids; and combination and additive therapies in children? 2. What is the most effective way of managing asthma with other health problems? 3. What are the key components of successful "Self Management" for a person with asthma? 4. What is the most effective strategy to educate people with asthma and health professionals about managing the adverse effects of drug therapies? 5. What is the most effective way of managing asthma triggers? 6. What is the role of complementary therapies in asthma management? 7. What are the benefits of breathing exercises as a form of physical therapy for asthma? 8. What type of patient (children and adults) and health professional education is most effective in gaining asthma control? 9. What is the most effective way to manage consultations and asthma control in adolescence and young people? 10. Psychological interventions for adults with asthma?


UK NICE (Guidelines)

Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care (CG101) Lung & airways Airways

UK NICE (Research recommendations)

Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO and Nobreath (DG12): 1) NICE also considered the role of FeNO measurement in asthma management. It accepted that currently available evidence on the use of FeNO measurement in asthma management is unclear on whether benefits of treatment are maintained long-term. NICE concluded that long-term studies following patients for several years could address this gap. 2) NICE also considered the role of FeNO in guiding inhaled corticosteroid dosing through stepping-up and stepping-down protocols. It accepted there is a need for more evidence on which protocols offer the safest and most optimal asthma management when used in UK clinical practice. Therefore, further studies are recommended, with consideration for the different protocols and cut-off points that may be necessary in different populations. 3) NICE discussed the potential for future research. NICE accepted that there is a need to further establish the accuracy of current practice in diagnosing asthma and the incremental accuracy associated with the addition of FeNO testing.


UK Scottish Intercollegiate Guideline Network (SIGN)

Asthma: The guideline is being updated to incorporate new evidence for recommendations on pharmacological, non-pharmacological and self management. (Update in progress, due Summer 2014)



CRG


Prepare for and respond to existing and emerging global threats to health: acute respiratoty infections (influenza, SARS), HIV/AIDS

Lung & airways

Acute Respiratory Infections

Spain CIBERES CIBERES has implemented the following 9 CRPs that include 32 research lines and 97 active research projects: Asthma, Sleep Apnea, Lung Cancer, COPD, Pulmonary Fibrosis, Acute Lung Injury, Pneumonia, Pathogen - Host interactions, Tuberculosis

Lung & airways


UK Medical Research Council (MRC)

Antimicrobial resistance: The growing resistance of micro-organisms to antimicrobial therapies such as antibiotics is a significant global Public Health issue. Too few new treatments are in development, and we need more diagnostics that will help us to match treatments with infections. The UK’s Chief Medical Offi cer has raised the alarm around antibiotic resistance (AMR), and the Department of Health has released a Five Year Antimicrobial Resistance strategy (2013-2018). The World Economic Forum has suggested that AMR be added to the global risk register, and the WHO has highlighted the serious implications for global Public Health in its AMR Global Report on Surveillance. Only a multidisciplinary approach will succeed in tackling the rise in AMR. The research councils, along with other UK funders, have been working together to identify a number of research opportunities and challenges to tackling the rise in AMR within four themes - 1: Understanding resistant bacteria in context of the host. 2: Accelerating therapeutic and diagnostics development. 3: Understanding the real world interactions. 4: Behaviour within and beyond the health care setting.

Lung & airways


UK NICE (Guidelines)

Bacterial meningitis & meningococcal septicaemia (CG102) Lung & airways

Acute Respiratory Infections USA USAID USAID with its partners in the U.S. Government and the global community are committed to the goal of ending

preventable child and maternal deaths. While many challenges remain, today, more than ever, we are equipped with the tools and knowledge to reach this goal. The health of mothers and children around the world is linked to improvements in maternal health, which inherently affect child health. Over the past two decades, there has been a nearly 50 percent reduction in maternal deaths, from 543,000 in 1990 to 287,000 in 2010. Meanwhile, the annual number of under-five deaths declined from 12.6 million in 1990 to 6.6 million in 2012. While under-five mortality is declining faster now than in the past two decades, with the annual rate of reduction more than tripling in 2005-2012 compared to the rate in 1990-1995, 18,000 children still die every day. The U.S. cannot act alone and in order to meet the Millennium Development Goal Four (Reduce Child Mortality) target by its agreed date of 2015, an additional 3.5 million children's lives above the current trend rate will need to be saved between 2013 and 2015.

Lung & airways



CRG


Support a high-quality, accessible and sustainable health-care system: drug safety, optimising the use of Electronic Health Records (EHRs), safety in long-term care facilities, recruitment and retention of physicians in rural regions and priority setting for new and expensive cancer drugs

Consumer & Communication Strategies


UK NICE (Guidelines) Medicines adherence (CG76) Consumer & Communication Strategies


UK NICE (Research recommendations)

Behaviour change: individual approaches (PH49): 1) How effective and cost effective are behaviour change interventions delivered remotely (that is, by telephone, text message, phone and tablet apps or the internet)? How does this vary among behaviours and among people from different sociodemographic groups? 2) Which combinations of behaviour change techniques and modes of delivery are effective and cost effective in initiating particular behaviour changes, and in maintaining those changes? How does this vary among people from different socio-demographic groups or with different levels of motivation, access to information or skills? Include research that builds the evidence base on the effectiveness of each behaviour change technique. For example, experimental and meta-analytic work could clarify which behaviour change techniques work when, and for whom? 3) How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice? 4) Which behaviour change interventions and programmes are effective and cost effective at changing multiple behaviours and maintaining behaviour change? How does this vary among people from different sociodemographic groups? 5) Which choice architecture interventions help to reduce increased-risk and higher-risk drinking of alcohol, improve sexual health behaviours, help stop or reduce smoking, or increase the physical activity levels of the general UK population? How is this related to sociodemographic variables? 6) What evidence of effectiveness is there on the use of choice architecture interventions in commercial settings to influence health-related behaviours? How can findings from commercial settings support non-commercial choice architecture approaches to support behaviour change to improve health? 7) What characteristics of behaviour change training influence the effectiveness of behaviour change practitioners?



USA Agency for Health Research Quality (AHRQ) Research Funding Priorities

AHRQ is interested in funding focused research demonstration projects that provide evidence to inform the safe use of health IT. (1) Clinical patient safety: Clinical patient safety topics impacted most by health IT. (2) EHR system integrity: Frequency of and optimal mitigation strategies for EHR downtimes. (3) Health IT safety reporting: Optimal health IT patient safety reporting strategies (4) Design, implementation, usability, and safe use of health IT by all users, including patients.



USA Patient-Centered Outcomes Research (PCORI)

Communication and dissemination research: (1) Research that compares alternative communication, dissemination, health literacy, and implementation strategies that aim to improve shared decision-making by empowering people to be more engaged, increasing clinician and patient awareness of healthcare options, and use of comparative effectiveness research results at the point of decision-making. (2) Research that compares the effectiveness, across a range of patient-centered outcomes, of alternative approaches to increase or encourage effective patient participation in care decisions and in shared decision-making. (3) Studies to develop and compare alternative methods and tools to include patient-desired outcomes in the healthcare decision-making process. (4) Research that compares innovative approaches in the use of existing electronic clinical data and other electronic modalities from the healthcare system or from a network of systems to enhance clinical decision-making by patients and providers.

Consumer & communication strategies


USA Patient-Centered Outcomes Research (PCORI)

Addressing disparities: (1) Research that compares interventions to reduce or eliminate disparities in health outcomes, for example, by accounting for possible differences in patient preferences or differences in response to therapy across socioeconomic, demographic, and other patient characteristics. (2) Research that compares benefits and risks of treatment, diagnostic, prevention, or service options across different patient populations, with attention to eliminating 18 disparities that are not a result of patient preference. (3) Research that compares strategies to overcome barriers (e.g., language, culture, transportation, homelessness, unemployment, lack of family/caregiver support that may adversely affect patients and is relevant to their choices for preventive, diagnostic, and treatment strategies or their outcomes. (4) Research that compares and identifies best practices within various patient populations for information sharing about treatment outcomes and patient-centered research.



Country Organisation Broad topic area

Specific topic area CRG

Australia NHMRC Dementia Dementia Dementia & Cognitive Improvement

Australia Pharmaceutical Benefits Scheme (PBS)

Dementia Is there more recent evidence on the safety and effi cacy of cholinesterase inhibitor (CEI) medicines to treat Alzheimer disease that would inform the PBAC about their cost-effectiveness?

Dementia & Cognitive Improvement

UK James Lind Alliance Dementia Dementia top 10 priorities: 1. What are the most effective components of care that keep a person with dementia as independent as they can be at all stages of the disease in all care settings? 2. How can the best ways to care for people with dementia, including results from research findings, be effectively disseminated and implemented into care practice? 3. What is the impact of an early diagnosis of dementia and how can primary care support a more effective route to diagnosis? 4. What non-pharmacological and/or pharmacological (drug) interventions are most effective for managing challenging behaviour in people with dementia? 5. What is the best way to care for people with dementia in a hospital setting when they have acute health care needs? 6. What are the most effective ways to encourage people with dementia to eat, drink and maintain nutritional intake? 7. What are the most effective ways of supporting carers of people with dementia living at home? 8. What is the best way to care for people with advanced dementia (with or without other illnesses) at the end of life? 9. When is the optimal time to move a person with dementia into a care home setting and how can the standard of care be improved? 10. What are the most effective design features for producing dementia friendly environments at both the housing and neighbourhood levels?

Dementia & Cognitive Improvement

UK NICE (Guidelines) Neurology Diagnosis, prevention and management of delirium (CG103) Dementia & Cognitive Improvement

UK NICE (Guidelines) Neurology Dementia: Supporting people with dementia and their carers in health and social care (CG42) Dementia & Cognitive Improvement

How useful are these data? Are there any other organisations or data that would be useful?

Do you already engage with any of these organisations to help set review production priorities?

Are some of the topics more useful than others, e.g. should we concentrate on priorities in guideline development?

Would it be useful to receive a list of priority topics area for your group and how might you use them?

What are the comparative merits of grouping priority topics by CRG vs. browse topic category?

Workshop plan Welcome and introductions

Presentation What does the target say? What are we planning? What have we done?

Discussion How can we build on what has been done? What can we learn? How can we maximise the usefulness of the work? Next steps?

David Tovey, Ruth foxlee and sera tort

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