Diagnostic Assessment Programs Research Articles

Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

Improving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a high-quality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. As a quality initiative of Cancer Care Ontario's Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback. The body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that DAP standards are needed (mean: 4.6), that standards should be formally approved (mean: 4.3), and importantly, that standards reflect an effective approach that will lead to quality improvements in the cancer system (mean: 4.5) and in patient care (mean: 4.3). Based on the best available evidence, standards for the organization of DAPS are offered. There is clear need to integrate formal and comprehensive evaluation strategies with the implementation of the standards to advance this field.

Redefining evidence

17000 Background: In the last decade, the Program in Evidence-based Care (PEBC), the guideline initiative of the cancer system in Ontario, Canada, has evolved dramatically. In addition to providing recommendations to facilitate decisions of clinicians (clinical practice guidelines), PEBC reports provide recommendations to facilitate decisions regarding universal drug funding, resource allocation, models of care, and the organization of the cancer system. For many of these issues, there is little in terms of traditional evidence, regardless of study design. As such, extending and building upon traditional notions of evidence and methodologies to gather new kinds of evidence have been required. Methods and Results: The PEBC has evolved the way it which conceives of evidence, the methods used to assemble and appraise evidence, and the role of evidence in decision making. To this end, environmental scan and consensus methods, in addition to standard systematic review methodology, are employed. The environmental scan methodology we use includes systematic and transparent internet searches of, and/or direct inquires to, organizations in jurisdictions determined, a priori, to be generalizable to the Ontario experience. Here, evidence comes in the form of organizational reports, case studies and evaluation data. These methods continue to be refined and tested. The consensus methodology we use is a modified Delphi technique. To date, these methods have been applied to various topics including standards for diagnostic assessment programs, surgical oncology and systemic therapy models of care, patient education, multidisciplinary case conferences, patient safety, and treatment of rare diseases. Evaluations of these reports have been generally positive (approval rating range: 56% to 75%) but noticeably more varied than approval ratings of our clinical practice guidelines that have relied primarily on traditional systematic review methodology (approval ratings rarely below 80%). Conclusions: The PEBC's notions of evidence continue to evolve as does the refinement and testing of new methodologies. Through this evolution, we are now able to provide advice on issues we would otherwise be unable to using traditional methods only, while still remaining true to our core principles of being participatory, rigorous, systematic and transparent. No significant financial relationships to disclose.

Towards innovative international classification and diagnostic systems: ICD‐11 and person‐centered integrative diagnosis

Towards innovative international classification and diagnostic systems: ICD‐11 and person‐centered integrative diagnosis

The American Medical Association's Diagnostic and Therapeutic Technology Assessment Program

Since its founding, the American Medical Association has been actively engaged in the assessment and dissemination of new medical knowledge and new technologies. About two years ago, the Council on Scientific Affairs of the AMA recommended to its Board of Trustees that a plan be developed for establishing a mechanism within the AMA to briefly and promptly answer questions that might arise on the safety and effectiveness of medical technologies. The Board of Trustees of the AMA approved that idea. A plan was then developed and has now finally been implemented. It is important to put the new effort in context. The Council on Scientific Affairs of the AMA has for years been preparing reports for the profession on many areas of medical technology that have been of substantive interest to the public and the medical profession because of their unique popularity or their controversial nature. In the past four

The American Medical Association's Diagnostic and Therapeutic Technology Assessment Program

Since its founding, the American Medical Association has been actively engaged in the assessment and dissemination of new medical knowledge and new technologies. About two years ago, the Council on Scientific Affairs of the AMA recommended to its Board of Trustees that a plan be developed for establishing a mechanism within the AMA to briefly and promptly answer questions that might arise on the safety and effectiveness of medical technologies. The Board of Trustees of the AMA approved that idea. A plan was then developed and has now finally been implemented. It is important to put the new effort in context. The Council on Scientific Affairs of the AMA has for years been preparing reports for the profession on many areas of medical technology that have been of substantive interest to the public and the medical profession because of their unique popularity or their controversial nature. In the past four