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Chapter 10: deciding whether to complement a systematic review of medical tests with decision modeling
Thomas A Trikalinos1, Shalini Kulasingam, William F Lawrence
1Center for Evidence-based Medicine, and Department of Health Services Policy and Practice, Brown University, Providence, RI 02912, USA. thomas_trikalinos@brown.edu
Journal of General Internal Medicine
|June 1, 2012
Summary
Most medical test reviews focus on accuracy, not patient outcomes. Modeling can link test performance to patient outcomes, improving medical test usefulness assessment.
Area of Science:
- Medical Decision Making
- Health Services Research
- Biostatistics
Background:
- Systematic reviews often prioritize test accuracy over patient outcomes.
- The relationship between test results and patient outcomes is complex and not guaranteed.
- Test performance alone is insufficient for evaluating medical test utility.
Purpose of the Study:
- To propose modeling as a framework for linking test performance to patient outcomes.
- To facilitate the interpretation of summary test performance measures.
- To connect medical testing and patient outcomes.
Main Methods:
- Utilizing decision or economic analysis modeling.
- Developing a simple algorithm for systematic reviewers.
- Illustrating the approach with a practical example.
Main Results:
- Modeling provides a natural framework to bridge test performance and clinical outcomes.
- The proposed algorithm aids reviewers in considering the impact of testing on outcomes.
- The example demonstrates the practical application of linking test performance to patient benefits.
Conclusions:
- Modeling is crucial for a comprehensive assessment of medical test usefulness.
- Connecting test performance data with patient outcomes enhances clinical decision-making.
- Systematic reviews should consider incorporating modeling to evaluate the true impact of medical tests.
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