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The Cochrane Collaboration
 

The Cochrane Collaboration

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The Cochrane Collaboration The Cochrane Collaboration Presentation Transcript

  • The Cochrane Collaboration’s Prioritization Approaches Lorne Becker: Co-Chair, Cochrane Collaboration Steering Group US Cochrane Center Conference on Priority Setting for Systematic Reviews July 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
  • Cochrane Decision Making
    • Primarily bottom up
      • Authors’ interests
      • Scope of editorial group (CRG)
    • Minimally top down
      • Methods
      • Procedures
      • Updating
  • 10 Cochrane Principles
    • #2 - Building on the enthusiasm of individuals,
    • - by involving and supporting people of different skills and backgrounds.
  • Opportunity Costs of Prioritization
  • 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?
  • Who Are Our Stakeholders?
  • Who Are Our Stakeholders?
  • Who Are Our Stakeholders?
  • Who Are Our Stakeholders?
  • 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
  • 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
  • Cochrane Authors (2007)
  • Who Are Potential Readers?
  • One Click Free Access
  • 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 6
    • Vote 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 criteria
      • Importance of the topic
      • Number of trials (0, 1, 2+)
      • Availability of experienced author team
  • Importance – Cochrane ID Group
    • 1 – Strategic Importance
      • Known interest from funders, policy makers or other key stakeholders
    • 2 – Potentially Important
      • WHO 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
  • 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
  • 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
  • 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
  • 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
  • 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 group
  • Conclusion
      • Prioritization is seen as desirable
      • But there are potential questions & difficulties
      • The Collaboration is proceeding deliberately
      • And hoping to learn from our experiences