Article type
Year
Abstract
Background: Cochrane Reviews are acknowledged to be rigorous, and their average quality is better than non-Cochrane reviews. Cochrane has developed a 'Strategy to 2020', that aims to put Cochrane evidence at the heart of health decision making all over the world. However, quality comes at a cost of currency, and the inability to conduct as many reviews as are needed to answer all relevant questions for decision makers.
Objectives: to evaluate how often a Cochrane Review is the best systematic review to answer a priority question needed by a Minister of Health.
Methods: the Ministry of Health of Chile is updating/generating their national guidelines in different topics relevant for health in Chile and trying to inform them with evidence. Our team performed searches and synthesis of evidence and generated a SoF table (GRADE: 'Summary of findings' table). In the evidence synthesis process, we searched for all systematic reviews that answered a question prioritized by a panel of experts, and we reused the best systematic review. The criteria for selecting the best systematic review were based on completeness (inclusion or exclusion of all relevant randomized trials) and thoroughness of the review process and synthesis (meta-analysis or narrative synthesis). So, we described how often a systematic review answered a question, and how often that is a Cochrane Review.
Results: we reviewed 50 guidelines with 359 question (4 to 16 questions for each guideline), of which 301 were treatment or prevention questions and 58 were diagnostic questions. Regarding estimation of effect of each intervention/test:
- Cochrane Reviews were used entirely (without the addition of new trials) in 73 questions (20.3%);
- non Cochrane reviews were used entirely (without the addition of new trials) in 82 questions (22.8%);
- Cochrane Reviews were used with the addition of lost trials in 7 questions (1.9%);
- non Cochrane reviews were used with the addition of lost trials in 11 questions (3.0%);
- meta-analyses were re-done in 100 questions (27.8%);
- narrative conclusions were re-done in 23 questions (6.4%);
- evidence synthesis of systematic reviews was used in 1 question (0.2%);
- some studies provided by a panel of experts were used in 3 questions (0.8%);
- no evidence (no study was found or all studies were excluded) was used in 61 questions (16.9%).
Conclusions: most questions can be answered with SRs (85%), but a few questions can be answered by a Cochrane Review alone (20.3%). So coverage, comprehensiveness and quality of Cochrane Reviews is far from ideal. Major changes are needed in Cochrane's production model in order to remedy this problem.
Patient or healthcare consumer involvement: a panel of experts determined by Ministry of Health of Chile elaborated and prioritized questions.
Objectives: to evaluate how often a Cochrane Review is the best systematic review to answer a priority question needed by a Minister of Health.
Methods: the Ministry of Health of Chile is updating/generating their national guidelines in different topics relevant for health in Chile and trying to inform them with evidence. Our team performed searches and synthesis of evidence and generated a SoF table (GRADE: 'Summary of findings' table). In the evidence synthesis process, we searched for all systematic reviews that answered a question prioritized by a panel of experts, and we reused the best systematic review. The criteria for selecting the best systematic review were based on completeness (inclusion or exclusion of all relevant randomized trials) and thoroughness of the review process and synthesis (meta-analysis or narrative synthesis). So, we described how often a systematic review answered a question, and how often that is a Cochrane Review.
Results: we reviewed 50 guidelines with 359 question (4 to 16 questions for each guideline), of which 301 were treatment or prevention questions and 58 were diagnostic questions. Regarding estimation of effect of each intervention/test:
- Cochrane Reviews were used entirely (without the addition of new trials) in 73 questions (20.3%);
- non Cochrane reviews were used entirely (without the addition of new trials) in 82 questions (22.8%);
- Cochrane Reviews were used with the addition of lost trials in 7 questions (1.9%);
- non Cochrane reviews were used with the addition of lost trials in 11 questions (3.0%);
- meta-analyses were re-done in 100 questions (27.8%);
- narrative conclusions were re-done in 23 questions (6.4%);
- evidence synthesis of systematic reviews was used in 1 question (0.2%);
- some studies provided by a panel of experts were used in 3 questions (0.8%);
- no evidence (no study was found or all studies were excluded) was used in 61 questions (16.9%).
Conclusions: most questions can be answered with SRs (85%), but a few questions can be answered by a Cochrane Review alone (20.3%). So coverage, comprehensiveness and quality of Cochrane Reviews is far from ideal. Major changes are needed in Cochrane's production model in order to remedy this problem.
Patient or healthcare consumer involvement: a panel of experts determined by Ministry of Health of Chile elaborated and prioritized questions.