The Cochrane Collaboration’s Prioritization Approaches Lorne Becker: Co-Chair, Cochrane...
-
Upload
barrie-cummings -
Category
Documents
-
view
217 -
download
0
Transcript of The Cochrane Collaboration’s Prioritization Approaches Lorne Becker: Co-Chair, Cochrane...
The Cochrane Collaboration’sPrioritization Approaches
Lorne Becker: Co-Chair, Cochrane Collaboration Steering Group
US Cochrane Center Conference on Priority Setting for Systematic ReviewsJuly 10 2008, Baltimore, USA
Outline of presentation
Dangers & difficulties in prioritization Cochrane approaches to prioritization
– Individual Cochrane “entities”– Organization-wide
Dangers and difficulties
• Is prioritization compatible with the Cochrane way of doing things?
• What are the opportunity costs?• Whose priorities would we follow?
How Cochrane Review Topics are Chosen
Curiosity driven Investigator-initiated Peer-reviewed
4
Cochrane Decision Making
Primarily bottom up– Authors’ interests– Scope of editorial group (CRG)
Minimally top down– Methods– Procedures– Updating
5
10 Cochrane Principles
#2 - Building on the enthusiasm of individuals,
- by involving and supporting people of different skills and backgrounds.
6
Opportunity Costs of Prioritization
7
Could Prioritization Help Focus Collaboration Efforts?
Prioritization helps decide what not to do Cochrane aim is to build a comprehensive
database of reviews– What to do first
Whose priorities should we use?
9
Who Are Our Stakeholders?
10
Who Are Our Stakeholders?
11
Who Are Our Stakeholders?
12
Who Are Our Stakeholders?
13
Priority setting
Be sure not to miss important perspectives or stakeholders
How would these Cochrane reviews have been prioritized?
Routine perineal shaving on admission in labor
Episiotomy for vaginal birth
Countries With Cochrane Contributors
16
Diabetes Prevalence
www.WorldMapper.org
Tuberculosis Prevalence
www.WorldMapper.org
HIV Prevalence
www.WorldMapper.org
Women Smokers
www.WorldMapper.org
Location of Cochrane Review Groups
21
Cochrane Authors (2007)
22
Who Are Potential Readers?
23
One Click Free Access
24
Cochrane Prioritization Processes
Until 2006 No central prioritization process Each of the 52 editorial groups responsible
for setting its own priorities Variety of approaches
Skin Group
21 titles proposed for development Resources allow only 6Vote by Skin Group Members vote to rank
titles in order of priority. – Authors– Editors– Peer reviewers– Consumers
Skin Group – results of prioritisation
Sentinel node biopsy followed by elective node dissection for early malignant melanoma.
Maintenance treatment for chronic plaque type psoriasis. Topical corticosteroids for atopic eczema. Interventions for erosive lichen planus. Interventions for mycosis fungoides. Concomitant hyperthermia and radiation for recurrent or
metastatic malignant melanoma.
Renal Group
Examination of Trial Register by staff Identification of important studies Group studies into broad topical areas Split each topic into several manageable
reviews. Post list of priority topics on web site
Infectious Diseases Group
Interplay of 3 criteria1. Importance of the topic2. Number of trials (0, 1, 2+)3. Availability of experienced author
team
Importance – Cochrane ID Group
1 – Strategic ImportanceKnown interest from funders, policy makers or other
key stakeholders
2 – Potentially ImportantWHO Millennium Development Goals
Health in Developing Countries
3 – Minimal relevance to MDGs
Health Promotion & Public Health Group
Taskforce of advisors from global health organizations
– Identified “policy-urgent topics”
Literature review for existing SRs– List of potential review topics to fill the gaps
Prioritization of the list by the Advisor taskforce Dissemination throughout the Collaboration to
relevant editorial groups– Formation of a Health Promotion & Public Health editorial group
J Epidemiol Community Health 2005;59:193–197
Steering Group Perspective
A key recommendation of the 2006 Steering Group review
Half day session at 2006 mid year meetings £100,000 to fund prioritization projects
32
Cochrane Prioritization Projects
Top down vs. Bottom up– Call for proposals from Cochrane entities
Opportunity Costs– £100,000 from central Cochrane funds
Whose Priorities?– Up to applicant entities to decide
33
Collaboration between a Cochrane Review Group and a Cochrane Field
Condition:– Hip fracture rehabilitation
Cochrane Entities:– Bone, Joint and Muscle Trauma Review Group– Health Care of Older People Field
Whose Priorities?– Members of the CRG and the Field
34
A patient-professional partnership approach
Condition:- Incontinence
Cochrane Entities:– Cochrane Incontinence Review Group
Collaborators:– The James Lind Alliance– a UK-based patient support charity
Whose Priorities?– 30 patient and professional advocacy groups
Using practice guidelines to determine review priorities
Condition:– Eye and Vision Disorders
Cochrane Entities:– US Cochrane Centre– Eyes and Vision Review Group
Whose Priorities?– International clinical experts
36
Prioritisation of Cochrane reviews for consumers and the public
Condition:– Any with a current Cochrane Review
Cochrane Entities:– Cochrane Consumer Network
Whose Priorities?– Consumers in low and middle income countries
Identify Reviews most in need of updating
37
Reducing the know-do gap in low and middle income countries
Condition:– Relevant to most disadvantaged in LMICs
Cochrane Entities: Health Equity Field Health Promotion & Public Health Field Developing Countries Network EPOC Review Group
Whose Priorities?– Experts on health of the disadvantaged in LMICs
Similar methodology to HPPH group38
Conclusion
Prioritization is seen as desirable
But there are potential questions & difficulties
The Collaboration is proceeding deliberately
And hoping to learn from our experiences
39