States can learn from the history of and progress that other countries have made.

Alternative Models for a U.S. National Clinical Effectiveness Assessment Program

The committee considered three approaches to establishing the Program infrastructure: maintaining the status quo and two alternatives (described below). Table 6-3 compares key aspects of the status quo with the two proposed alternatives: a central agency and a hybrid model. Both alterna-

TABLE 6-3 Alternative Approaches to Organizing the Program: Administrative Structure and Primary Functions

Organizational Feature or Function

Status Quo

Structure

 

Administrative infrastructure

No change.

Degree of program control over clinical effectiveness assessment process

There is no change, except when sponsored by the AHRQ Effective Health Care Program.

Primary functions

 

Setting research priorities

Multiple public and private entities set program- or mission-specific priorities. AHRQ sets priorities as directed by the secretary of the U.S. Department of Health and Human Services.

Assessing evidence

Multiple, independent organizations operating without oversight. No standardized mechanisms for quality assurance and quality control.

Developing clinical guidelines/recommendations

Multiple, independent organizations operating without oversight. Multiple, voluntary practice guidelines are available. No standardized mechanisms for quality assurance and quality control; claims of evidence base not necessarily supported by methods.



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