![]() The better the test, the closer the ROC curve approaches the top left-hand corner, which represents the combination of 100% sensitivity and 100% specificity. As all tests can have false-positive and false-negative results, the next test in a series will reclassify some people correctly and others incorrectly as illustrated in figure 1.Īn ROC curve is a plot of sensitivity against (1−specificity), and shows the test's performance. When a diagnostic test is performed, it will classify people as having or not having a condition. ![]() Tests will usually be done in a sequence, beginning with the cheapest and least invasive (ie, history and physical examination) as illustrated in figure 6. Information on the relative performance of tests may be easier to obtain. Ideally, tests should be assessed in terms of their ability to improve patient-important outcomes, but this information is unfortunately often not available. (1) Does using the test improve patient outcomes? (2) Does using the test improve on information provided by the history, examination and other cheaper or more readily available tests? (3) How accurate is the test? Base testing practices on the best available evidenceĭecisions about using a diagnostic test should be based on critically appraised evidence on three key questions. It quickly became apparent that examples of low-quality, low-value testing practices are not confined to one small group of NHS hospitals in England, but are common internationally in both primary and secondary care, and that a comprehensive framework would be useful for trainees, trainers, practitionersand commissioners. The scope of the structure and the accuracy of the contents were informed by critical discussion on the Evidence-Based Healthcare email list and the anonymous reviewers. Respondents had good reason for concern about testing practices because the survey identified 121 tests (listed in the online Appendix) that they thought provided low quality or poor value.īecause it was far from clear what training should cover, this framework for high-quality, high-value testing was developed. This was a frequent suggestion in a recent survey of doctors working in an NHS Foundation Trust with two large acute care hospitals. ‘Training is required to ensure testing practices provide high-quality, high value care’.
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