care spending is weakening American industry’s competitive edge and in the global economy, and this burden is increasingly being transferred to consumers as they are held more financially at risk for the health care services that they use (Gabel et al., 2002; U.S. Government Accountability Office, 2006a,b; Webster, 2006). Enabling and incentivizing “consumer choice” is viewed by some as a potential market strategy to rationalize what most agree is a health care system plagued by overuse, underuse, and misuse (Schwartz, 1984; Wennberg, 2004). Yet even the most sophisticated health care consumer struggles to learn which care is appropriate for his or her circumstance and to obtain it at the right time (Berwick, 2003; Rettig et al., 2007; Wennberg, 2002).

With these trends in view, the Robert Wood Johnson Foundation (RWJF) asked the Institute of Medicine (IOM) to address problems in how the nation uses scientific evidence to identify the most effective clinical services. The IOM appointed the Committee on Reviewing Evidence to Identify Highly Effective Clinical Services in June 2006 to respond to RWJF’s request and prepare this report. The 16-member committee included experts in clinical research, health care coverage, drug development, health care benefits selection (large employers and other purchasers), health care delivery, clinical guideline development, economics, statistical methods and epidemiology, consumer and patient perspectives, child health, preventive medicine, behavioral health, and ethics. Brief biographies of the committee members appear in Appendix G.


The committee was charged with recommending a sustainable, replicable approach to identifying and evaluating the clinical services that have the highest potential effectiveness. The charge specified three principal tasks:

  1. To recommend an approach to identifying highly effective clinical services across the full spectrum of health care services—from prevention, diagnosis, treatment, and rehabilitation, to end-of-life care and palliation

  2. To recommend a process to evaluate and report on evidence on clinical effectiveness

  3. To recommend an organizational framework for using evidence reports to develop recommendations on appropriate clinical applications for specified populations

The committee’s initial deliberations focused on articulating its charge in a strategic work plan for the 18-month study period. The committee chose to focus on developing an organizational framework for a national

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