'Hit, Miss or Maybe". An Analysis of the Usefulness ofCochrane Reviews to Commissioners of Health Care in one Health Region in the UK.

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Young J, Fry-Smith A

Introduction: ARIF is a unit that was set up in the West Midlands in 1996 to "Advance the use of evidence on the effects of health care in the region." This objective is achieved largely through the provision of timely access to, and advice on the application of, evidence from existing systematic reviews on the effects and effectiveness of health care. The main mechanism through which this activity takes place is an information service to commissioners of health care in the region. Since the unit was set up, around 150 formal requests for information have been received with an 85% hit rate in terms of potentially relevant reviews being identified. However, on less than 20% of these occasions did the relevant reviews originate from the Cochrane Collaboration. Following an appraisal process which assesses the external and internal validity of the review in the context of the question, only a tiny proportion of these Cochrane reviews identified are subsequently recommended for application.

Objectives: The objective of this analysis was to explore the possible reasons why Cochrane reviews are not identified and used by ARIF more often.

Methods: The authors retrospectively analysed the outcomes of all 150 requests in terms of the proportion of requests where a) relevant reviews were identified and b) subsequently recommended for application on the basis of their quality and relevance. These proportions were broken down by a) the source of the review using the main elements of the ARIF search protocol, and b) the type of review using 6 main categories; Cochrane reviews and protocols; NHS CRD reviews and Effective Health Care Bulletins; national health technology assessments; international health technology assessments; locally initiated health technology assessments; and others. Finally, in requests where reviews were identified, the reasons why they were or were not recommended were explored through a) a classification of their external validity in relation to the target question using the categories; hit; miss; or maybe, and b) a classification of their internal validity using the categories; systematic review with a meta-analysis; systematic review with no (or inappropriate) meta-analysis; comprehensive overview with clearly stated method; review with clearly stated method; general review; other.