Design of Case Report Forms: Design of Case Report Forms David W. Mailhot February 7, 2006 Case Report Form: Case Report Form ..CRF Official clinical data-recording document or tool used in a clinical study RDC/RDE (Remote Data Capture, Remote Data Entry) PAPER Purpose: Purpose Collects relevant data in a specific format in accordance with the protocol compliance with regulatory requirements Allows for efficient and complete data processing, analysis and reporting Facilitates the exchange of data across projects and organizations esp. through standardization CRF Relationship to Protocol: CRF Relationship to Protocol Protocol determines what data should be collected on the CRF All data must be collected on the CRF if specified in the protocol Data that will not be analyzed should not appear on the CRF CRF Development : CRF Development Guidelines Collect data with all users in mind Collect data required by the regulatory agencies Collect data outlined in the protocol Be clear and concise with your data questions Avoid duplication Request minimal free text responses CRF Development: CRF Development Guidelines (con’t) Provide units to ensure comparable values Provide instructions to reduce misinterpretations Provide “choices” for each questions allows for computer summarization Use “None” and “Not done” CRF Development: CRF Development Guidelines (con’t) Collect data in a fashion that: allows for the most efficient computerization similar data to be collected across studies CRF book needs to be finalized and available before an investigator starts enrolling patients into a study Take the time to get it right the first time Elements of the CRF: Three major parts: Header Safety related modules Efficacy related modules Module block of specific questions CRF module(s) make up a single CRF page CRF Book series of CRF pages Elements of the CRF Header Information: Header Information Key identifying Information MUST HAVES Study Number Site/Center Number Subject identification number Creating Safety Modules: Creating Safety Modules Usually come from a standard library Select modules appropriate for your study Keep safety analysis requirements in mind Safety Modules usually include Demographic Adverse Events Vital Signs Medical History/Physical Exam Concomitant Medications Patient Disposition Efficacy Modules: Efficacy Modules Designed for each therapeutic area based on the protocol Considered to be “unique” modules and can be more difficult to develop Use existing examples from similar protocols where applicable Consider developing a library of efficacy pages Design modules following project standards for data collection Creating Efficacy Modules: Creating Efficacy Modules Follow general CRF design guidelines Use pages or modules from the therapeutic library Define diagnostics required Include appropriate baseline measurements Repeat same battery of tests Define and identify key efficacy endpoints additional tests for efficacy Importance of Standard CRFs: Importance of Standard CRFs Prepares the way for data exchange Removes the need for mapping during data exchange Allows for consistent reporting across protocols, across projects Promotes monitoring and investigator staff efficiency Allows merging of data between studies Provides increased efficiency in processing and analysis of of clinical data CRF Development Process: CRF Development Process CRF Designer Reviewers CRF Designer CRF Book Drafts CRF from protocol CRF Review Meeting Comments back to designer Updates CRF to incl. comments Review and Sign off Coordinate printing and distribution Site CRF Development Process: CRF Development Process Responsibility for CRF design can vary between clinical research organizations (CRA, data manager, specialty role) Include all efficacy and safety parameters specified in the protocol using standards libraries To collect ONLY data required by the protocol Work with protocol grid/visit schedule CRF Development Process: CRF Development Process Interdisciplinary review is necessary each organization has its own process for review/sign-off Should include relevant members of the project team involved in conduct, analysis and reporting of the trial Begins As soon in the study prep process as possible CRF Development Process: CRF Development Process Review Team (example) Project Clinician Lead CRA Lead Statistician Lead Programmer Lead Data Manager Others Database Development, Dictionary Coding, Standards CRF Development Process: CRF Development Process After the CRF book is approved Initiate the process for printing Note: the Protocol must be approved before the CRF book is approved and printed After it is printed Stored according to organizational guidelines Printed and distributed to research sites Properly Designed CRF: Properly Designed CRF Components/All of the CRF pages are reusable Saves time Saves money + Poorly Designed CRF: Poorly Designed CRF Data not collected Database may require modification Data Entry process impeded Need to edit data Target dates are missed Collected too much data – Wasted resources in collection and processing Poorly Designed CRF Issues: Poorly Designed CRF Issues = The Case Report Form: The Case Report Form How do we use it? Collect data from the investigational sites Helps project team and study site team Reminder to investigator to perform specific evaluation CRA uses to verify protocol is being followed and compare with source documents Biometrics uses it to build database structures, develop edit checks and programming specs The Case Report Form: The Case Report Form ...Used for Subject tracking Data analysis and reporting Reports to FDA on subject safety e.g.. APR Promotional materials New Drug Application submissions Support of labeling claims Articles in medical journals Electronic CRFs : Electronic CRFs The use of RDC is increasing In general, the concepts for the design of electronic CRFs/RDC screens are the same as covered for paper Electronic CRFs will impact the following: Review of CRF is different (screen review) No need to print and distribute paper Examples: Examples Questions ?: Questions ?