Cochrane Wounds is embedded within the Wounds Research Group at the University of Manchester and we have an over-arching, integrated approach to prioritisation which prioritises uncertainties (or questions) rather than methods or designs. The Wounds Research Group led, until September 2019, the Wound Care Research Programme of the NIHR CLAHRC Greater Manchester. This Programme worked closely with stakeholders in the health system of Greater Manchester to increase the volume, quality and responsiveness of wounds research. We conducted a comprehensive analysis of the management of more than 2000 people with complex wounds to identify treatments being used in practice and unintended variations in practice (which are signals of uncertainty).
The CLAHRC work also included a formal prioritisation process with NHS stakeholders that yielded 158 “raw” uncertainties, further prioritised to a final 25 identified as high priority for decision makers. All these data are used to prioritise updates and new reviews. This process is described in more detail in a paper co-authored by our Joint Coordinating Editors: Rapid research and implementation priority setting for wound care uncertainties1. In addition, we continue to respond to the priorities generated by a previous James Lind Priority Setting Partnership for Pressure Ulcers to ensure reviews in these areas respond to service-user demand.
Our Coordinating Editors are closely involved in the NHS England National Wound Care Strategy Programme which is ensuring that we identify high priority topics relevant to pressure ulcers, lower limb ulcers and surgical wounds where systematic reviews are needed. Cochrane Wounds has a very close collaboration with Manchester University NHS Foundation Trust (MFT), one of the largest health care providers in Europe, covering 10 hospitals and community services. Our Coordinating Editors are members of the Manchester Wound Care Group which is developing a wound care strategy for Manchester and identifying priorities for research (including systematic reviews), education and practice.
Any new review proposals are scrutinised for relevance and importance by our editors and our international clinical prioritisation team, to ensure that only reviews in relevant and high priority topics are adopted. We may then consult further with health professionals working in the clinical areas relevant to high priority topics (e.g. wounds in the acute care setting and burns/scars) for more guidance.
Our editors and clinical prioritisation team members are asked to consider whether:
- review questions are important (and the intervention is currently in use)
- they are aware of relevant trials in this area
- the title overlaps with existing reviews
Information from our stakeholder prioritisation as described above, is discussed in our regular prioritisation meetings. As well as considering new review proposals, we also review protocols and reviews in progress and updates which are either in progress or due for updating, and consider these in conjunction with usage statistics, national prescribing data (evidence of high use of/high expenditure on an intervention), inclusion in national guidelines (e.g. NICE) and the results of scoping searches for trials for possible inclusion. Where we are aware that a large study in a topic area that meets other prioritisation criteria is in the analysis phase and likely to publish soon, we prioritise the incorporation of the new evidence into the existing systematic review. Based on this collective assessment we categorise all titles, protocols, reviews and updates as being of high, medium or low priority. We use this priority list to drive important reviews and updates forward.