Charge to the IOM Committee

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

services. Three functions would be central to this mission: setting priorities for evidence assessment, assessing evidence (systematic review), and developing (or endorsing) standards for trusted clinical practice guidelines.


The committee based its work on the central premise that decisions about the care of individual patients should be based on the conscientious, explicit, and judicious use of current best evidence. This means that individual clinical expertise should be integrated with the best information from scientifically based, systematic research and applied in light of the patient’s values and circumstances. Centering decision making on the patient is integral to improving the quality of health care and is also imperative if consumers are to take an active role in making informed health care decisions based on known risks and benefits. This report also recognizes that health care resources are finite. Thus, setting priorities for systematic assessment of scientific evidence is essential.

The era of physician as sole health care decision maker is long past. In today’s world, health care decisions are made by multiple people, individually or in collaboration, in multiple contexts for multiple purposes. The decision maker is likely to be the consumer choosing among health plans, patients or patients’ caregivers making treatment choices, payers or employers making health coverage and reimbursement decisions, professional medical societies developing practice guidelines or clinical recommendations, regulatory agencies assessing new drugs or devices, or public

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