Huddy Jeremy R, Ni Melody, Mavroveli Stella, Barlow James, Williams Doris-Ann, Hanna George B
Department of Surgery and Cancer, Imperial College, London, UK.
Imperial College Business School, South Kensington Campus, London, UK.
BMJ Open. 2015 Jul 10;5(7):e007840. doi: 10.1136/bmjopen-2015-007840.
Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS).
A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise.
The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations.
即时检验体外诊断(POC-IVD)作为一种可接受的手段,越来越广泛地用于提供快速诊断结果,以促进许多临床路径中的决策制定。目前,关于其效用、可用性和成本效益的证据是以零散且不相关的方式呈现的,鉴于这些检测对临床路径具有颠覆性,这充满了方法学挑战。即时检验关键证据工具(POCKET)清单旨在提供一个基于证据的综合框架,纳入所有所需证据,以指导对POC-IVD的评估,满足英国国家医疗服务体系(NHS)政策制定者和决策者的需求。
将采用多方法途径来开发POCKET。全面的文献综述构成了稳健的德尔菲法和验证研究的基础。正在与POC-IVD利益相关者进行半结构化访谈,包括行业、监管机构、采购方、临床医生和患者,以了解促进决策需要哪些证据。新出现的主题将转化为一系列陈述,形成一份调查问卷,旨在就工具应包含的内容在每个利益相关者群体中达成共识。结果将提交给一个研讨会,讨论提出的陈述和工具的最佳形式。一旦组装完成,该工具将通过案例研究进行实地测试,以确保有效性和可用性,并在需要时为改进提供信息。最终版本将在网上发布并征求意见。局限性包括样本代表性不可预测、形成折衷立场而非达成共识,以及验证过程中缺乏盲法。
帝国理工学院联合研究合规办公室和帝国理工学院医疗保健NHS信托研发部门已批准该方案。清单工具将通过博士论文、网站、同行评审出版物、学术会议和正式报告进行传播。