Application of diagnostic accuracy methods in a health systems context: task-shifting of diagnostic procedures

Session: 

Oral session: Priority setting (3)

Date: 

Monday 17 September 2018 - 12:00 to 12:20

Location: 

Ochil 1

All authors in correct order:

Mansilla C1, Herrera C2, Pantoja T2
1 Ministry of Health of Chile, Chile
2 Pontificia Universidad Católica de Chile, Chile
Presenting author and contact person

Presenting author:

Tomas Pantoja

Contact person:

Cristián Mansilla
Tomas Pantoja
Abstract text
Background: One of the main barriers to achieve universal health coverage is the relative lack of physicians in many health systems. Task-shifting (TS) is one potential solution, considering that some healthcare services can be delegated from physicians to other professionals, or from specialists to general practitioners. However, one of the main concerns regarding this strategy – especially in the case of diagnostic procedures - is the safety of the services delivered to patients.

In the context of a rapid review program at the Ministry of Health in Chile – a n initiative aiming at answering policy questions by producing evidence syntheses in a timely manner- a rapid evidence synthesis about TS in certain diagnostic procedures has been produced.

Objectives: To present a new method to measure the risk of delegating specific diagnostic procedures to a different cadre of health professional, by applying diagnostic accuracy (DA) methods to a health system problem, in the context of a rapid review program.

Methods: This presentation has two parts. Firstly, we describe the rapid evidence synthesis methods used to apply DA in a TS problem. Secondly, we show a practical application of this method in two questions:
1) safety of shifting ultrasound to non-physician professionals; and
2) interpretation of electrocardiograms by a non-cardiologist physician.

Results: We use meta-analysis of sensitivities and specificities. Later, we appraise the quality of the evidence using the GRADE approach. As a result of using these two rapid evidence syntheses, in the first question, a public policy is being developed to delegate sonographies, whereas the second question is currently being explored, with the use of telemedicine.

Conclusions: We applied an innovative rapid review approach to answer health systems questions, and specifically to address how safe the delegation of certain diagnostic procedures would be.

Patient or healthcare consumer involvement: In order to implement a TS strategy, it is also important to learn about the values and preferences of patients and consumers. Then, policy dialogues are conducted to present the evidence of these syntheses to patients and consumers, and discuss their values and preferences. The evidence and patients’ views will be two important inputs for a health policy decision-making scenario.

Relevance to patients and consumers: 

Task-shifting is one of the main health policy strategies available to reduce the gap for human resources for health, especially physicians. This gap has also equity implications, since rural and underserved communities are commonly affected for a lack of health professionals. However, it is important for patients and consumers the procedures that they receive have safety standards, particularly when it is not delivered by a specialist. Then, this presentation will explore an easy method to use evidence to compare the diagnostic accuracy of non-physician health professionals to conduct relevant medical procedures.