ensuring an effective health care system. There is little value to identifying effective services or developing evidence-based practice guidelines, if the knowledge gained does not lead to higher quality health care delivery and improved patient outcomes. However, setting standards for best practices (e.g., through clinical guidelines) differs fundamentally from successfully implementing them through quality improvement projects, which take place at a local level.


The committee deliberated during 5 in-person meetings and 14 telephone conferences between July 2006 and October 2007. As previously noted, during its early discussions, the members of the committee agreed to first develop a strategic work plan for organizing the study. This soon led to a primary focus on three processes deemed integral to identifying effective health care services.

Given the dynamic nature of the issues involved in the study, the committee decided to supplement its planned review of the relevant literature with expert testimony on current issues. It thus convened two public workshops. The first workshop, held in November 2006, focused on evidence generation, evidence synthesis, and evidence assessment of new health care technologies and new applications of existing technologies. The committee heard testimony from various experts, including the developers of health care technologies, government regulators, research scientists, and technology assessors, on their experiences with the use of positron emission tomography scanning for the diagnosis of Alzheimer’s disease; pharmacotherapy with bevacizumab (Avastin) and ranibizumab (Lucentis) for age-related macular degeneration; and two technologies related to the early identification and treatment of colorectal cancer; the fecal DNA screening test and an assay to test toxicity for the chemotherapy agent irinotecan.

The second workshop, held in January 2007, focused on organizations that set priorities for developing systematic reviews, clinical practice guidelines, and practice standards. The committee heard testimony from senior representatives of the Agency for Healthcare Research and Quality (AHRQ), the U.S. Preventive Services Task Force (USPSTF), Consumers Union’s Best Buy Drugs, the American Heart Association (in collaboration with the American College of Cardiology), the National Quality Forum, the National Committee for Quality Assurance, the Joint Commission, the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement, UnitedHealthcare, the Cochrane Collaboration, the Blue Cross and Blue Shield Association Technology Evaluation Center (an Evidence-based Practice Center), Johnson & Johnson, the ECRI Institute, Genentech, and the Dartmouth-Hitchcock Department of Ortho-

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