The Cochrane Collaborations Prioritization Approaches

1
The Cochrane CollaborationsPrioritization
Approaches

• Lorne Becker Co-Chair,
• Cochrane Collaboration Steering Group
• US Cochrane Center Conference on Priority Setting
  for Systematic Reviews
• July 10 2008, Baltimore, USA

2
Outline of presentation

• Dangers difficulties in prioritization
• Cochrane approaches to prioritization
• Individual Cochrane entities
• Organization-wide

3
Dangers and difficulties

• Is prioritization compatible with the Cochrane
  way of doing things?
• What are the opportunity costs?
• Whose priorities would we follow?

4
How Cochrane Review Topics are Chosen

• Curiosity driven
• Investigator-initiated
• Peer-reviewed

5
Cochrane Decision Making

• Primarily bottom up
• Authors interests
• Scope of editorial group (CRG)
• Minimally top down
• Methods
• Procedures
• Updating

6
10 Cochrane Principles

• 2 - Building on the enthusiasm of individuals,
• - by involving and supporting people of
  different skills and backgrounds.

7
Opportunity Costs of Prioritization
8
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

9

• Whose priorities should we use?

10
Who Are Our Stakeholders?
Consumers?
Clinicians?
Spouses, Families, Caregivers?
11
Who Are Our Stakeholders?
Policy Makers?
Consumers?
Clinicians?
Guideline Writers?
Spouses, Families, Caregivers?
Advocacy Groups?
12
Who Are Our Stakeholders?
Policy Makers?
Consumers?
Clinicians?
Guideline Writers?
Researchers?
Spouses, Families, Caregivers?
Methodologists?
Advocacy Groups?
13
Who Are Our Stakeholders?
Of Research?
Funders?
Policy Makers?
Consumers?
Clinicians?
Guideline Writers?
Researchers?
Spouses, Families, Caregivers?
Methodologists?
Of Health Care?
Advocacy Groups?
Of Reviews?
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Priority setting

• Be sure not to miss important perspectives or
  stakeholders

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How would these Cochrane reviews have been
prioritized?

• Routine perineal shaving on admission in labor
• Episiotomy for vaginal birth

16
Countries With Cochrane Contributors
17
Diabetes Prevalence
www.WorldMapper.org
18
Tuberculosis Prevalence
www.WorldMapper.org
19
HIV Prevalence
www.WorldMapper.org
20
Women Smokers
www.WorldMapper.org
21
Location of Cochrane Review Groups
22
Cochrane Authors (2007)
23
Who Are Potential Readers?
24
One Click Free Access
25
Cochrane Prioritization Processes

• Until 2006
• No central prioritization process
• Each of the 52 editorial groups responsible for
  setting its own priorities
• Variety of approaches

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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

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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.

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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

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Infectious Diseases Group

• Interplay of 3 criteria
• Importance of the topic
• Number of trials (0, 1, 2)
• Availability of experienced author team

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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

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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 200559193197
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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

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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

34
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

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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

36
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

37
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

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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

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Conclusion

• Prioritization is seen as desirable
• But there are potential questions difficulties
• The Collaboration is proceeding deliberately
• And hoping to learn from our experiences