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effectivehealthcare.ahrq.gov/sites/default/files/pdf/test-performance-metrics_appendixes.pdf
January 01, 2005 - A-1
Appendix: Test Performance Metrics
The basic definitions of test performance are based upon … It expresses the ability of a medical test to maximize true positives. … It expresses
the ability of a test to minimize false positives. … If the threshold (cutpoint) for
test positive is set higher—say when the test provides a continuously … How to
use an article about a diagnostic test. B.
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/prostate-cancer-test_executive.pdf
April 01, 2013 - 11
Also, issues such as who to test, when
to test and retest, and the most effective
clinical tPSA … The intended use of
the test is to inform decisionmaking about repeat biopsy. … An AUC of 1.0 indicates a perfect
test, and an AUC of 0.5 indicates a worthless test.
4
matching … was preserved by computing differences
between PCA3 test results and comparator test results
within … The effect of even a great test is limited if uptake is
low.
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effectivehealthcare.ahrq.gov/products/test-performance-metrics
June 01, 2012 - Appendix: Methods Guide for Medical Test Reviews: Test Performance Metrics
Timeline … Initiated
June 01, 2012
Methods Guide – Chapter
Appendix: Test
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effectivehealthcare.ahrq.gov/products/test-performance-metrics/appendixes/
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/prostate-cancer-test_research-protocol.pdf
October 14, 2011 - Was the reference standard independent of the index test (i.e., the index test did not form
part of … Was the execution of the index test described in sufficient detail to permit replication of the
test … when the test is used in practice? … For the pooled
results, was a test done to assess homogeneity (i.e., Chi-squared test, I2)? … but decrease test specificity.
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-bias_methods.pdf
July 01, 2012 - in
Medical Test Studies
P. … Variation in test technology
When the characteristics of a medical test change over time as a result … of an index test. … the
sensitivity and specificity of the test may lead to over-optimistic measures of
test performance … Risk: Low/High/Unclear
Domain 2: Index Test(s) (complete for each index test used)
Were the index
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-metaanalysis_methods.pdf
July 01, 2012 - Methods Guide for Medical Test Reviews
8-1
Chapter 8
Meta-Analysis of Test Performance
When … Introduction
The Methods Guide to Medical Test Reviews (also referred to as the Medical Test Methods … This chapter of the Medical Test Methods Guide focuses on choosing strategies for meta-
analysis of test … questions driving the evidence synthesis (e.g., “Is this test alone or in combination
with a test-and-treat … medical test evidence focuses on summarizing test
performance data; thus their meta-analysis was chosen
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effectivehealthcare.ahrq.gov/products/prostate-cancer-test
October 14, 2011 - PCA3 Testing for the Diagnosis and Management of Prostate Cancer
Timeline
May 04, 2011
Topic Initiated
October 14, 2011
Research Protocol
Archived
PCA3 Testing for the Diagnosis and Management of Prostate Cancer
April 01, 2013
Systematic Rev…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guide-editorial_methods.pdf
July 01, 2012 - Methods Guide for Medical Test Reviews - Editorial
E-1
Editorial
Methods Guide for Authors of … The most common outcome in
an evaluation of this test is the accuracy of the test in identifying clinically … Clinicians, while interested in this proxy outcome, would find more value in the
ability of the test … Cochrane Diagnostic Test Accuracy
Working Group. Handbook for DTA
reviews. … Editorial printed in Methods Guide for Medical Test Reviews
(AHRQ Publication No. 12-EHC017).
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-outcomes_methods.pdf
July 01, 2012 - Test Diagnostic Test Prognostic Test
Clinical management + +++ +++
Direct health effects + ++ ++ … , a
diagnostic test, and a prognostic test. … Costs of the test. … Direct test effects. The test under consideration is a radiographic test. … Costs of the test.
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-introduction_methods.pdf
July 01, 2012 - Guide
for Medical Test Reviews
David B. … This Methods Guide for Medical Test Reviews (referred to hereafter as the Medical Test
Methods Guide … Development of the Medical Test Methods Guide
In developing this Medical Test Methods Guide, we sought … Indeed, test
performance characteristics have been treated as sufficient criteria of test value (i.e … category
Diagnostic accuracy efficacy
Clinical validity
Test accuracy
Test performance
Performance
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-prognostic_methods.pdf
July 01, 2012 - A diagnostic test is used to help determine whether
a patient has a disease at the time the test is … Therefore, the “reference test” for a prognostic test is the observed
proportion of the population who … Much as for a diagnostic test, a systematic review of
a prognostic test could then assess the accuracy … Was the test used and interpreted the same way by all sites/studies including any interdeterminate test … Grouped Mortality Probabilities Estimated by the
First Prognostic Test + a New Prognostic Test
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effectivehealthcare.ahrq.gov/sites/default/files/medical-test-reviews-prognostic.ppt
June 01, 2012 - Methods guide for medical test reviews. … Methods guide for medical test reviews. … by the test. … Like a diagnostic test, a systematic review could then assess the accuracy of the prognostic test by … Was the test used and interpreted the same way by all sites/studies, including any indeterminate test
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-performance_methods.pdf
July 01, 2012 - performance compares the results of an
index test with a reference test. … Perhaps the simplest case of test performance evaluation includes an “index test” and a
reference test … Reference Test (-)
Index Test (+)
Index Test (-)
We now have five unknowns: the sensitivity … One
explores how well one test agrees with the other test(s), and perhaps asks if one test can be used … Comparison of a screening
test and a reference test in epidemiologic
studies. II.
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-topics_methods.pdf
July 01, 2012 - pathways, technical details of the test, characteristics of clinicians or operators using the test, … and logically flow from a test strategy. … as the old test and the new test
has advantages over the old test such as causing fewer adverse effects … those identified by the older test? … the old test
and the new test has advantages over the old test such as having fewer adverse effects
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-decision-models_methods.pdf
July 01, 2012 - Instead, one should compare complete
test-and-treat strategies (for which test performance is but a … Define how the test will be used. … (test-and-treat strategy) based on
considerations of test characteristics alone. … However, in other cases, harms can be induced both by the treatment and the test (e.g., if the test is … clinical
utility of a test.
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/medical-test-reviews-prognostic.ppt
June 01, 2012 - Methods guide for medical test reviews. … Methods guide for medical test reviews. … by the test. … Like a diagnostic test, a systematic review could then assess the accuracy of the prognostic test by … Was the test used and interpreted the same way by all sites/studies, including any indeterminate test
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-applicability_methods.pdf
July 01, 2012 - Test Studies
in Systematic Reviews
Katherine E. … test (i.e., as a replacement), but in reality the test is proposed to be used as a
triage test to guide … Exclude a priori if test
results cannot be
mapped to disease
status (i.e., 2x2 or
other test performance … Placement of test in
the sequence of care
(e.g. relationship of
test to treatment or
follow-on management … Routine Preventive Care Over Time
Routine use of a medical test as a screening test might be considered
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effectivehealthcare.ahrq.gov/products/prostate-cancer-test/research-protocol
October 14, 2011 - Was the reference standard independent of the index test (i.e., the index test did not form part of the … Was the execution of the index test described in sufficient detail to permit replication of the test? … the test is used in practice? … For the pooled results, was a test done to assess homogeneity (i.e., Chi-squared test, I 2 )? … but decrease test specificity.
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-guidance-tests-grading_methods.pdf
July 01, 2012 - (e.g., test versus no test) with clinical outcomes as the study endpoint, the reader is referred to … Common Challenges
Diagnostic test studies commonly focus on the accuracy of the test in making a disease … Of note, directness does
apply to how a test is used in comparison to another test. … evaluated is not the exact test used in practice,
or if the test accuracy is being calculated in a … Assessing risk of bias as a domain of quality in
medical test studies.