The Agency for Health Care Policy and Research (AHCPR) (now the Agency for Healthcare Research and Quality [AHRQ]) is created and given the responsibility for federal health services research by the Omnibus Budget Reconciliation Act of 1989 (P.L. 101-239). The agency’s Center for Medical Effectiveness Research forms several Patient Outcome Research Teams to study the outcomes and costs of alternative treatments for specific clinical problems.

The Council of Medical Specialty Societies convenes a national meeting to promote guidelines and training programs for specialty societies and commissions the creation of a manual of evidence-based methods (1987).

Significant methodological advances enable the generation and use of evidence in medical decisions. These include decision trees, utility theory, Bayes theorem for analyzing diagnostic tests, mathematical models, cost-effectiveness analysis, clinical epidemiology, outcomes assessment, meta-analysis, and systematic review.

The U.S. Preventive Services Task Force (USPSTF) is convened in 1984 to evaluate research and issue guidelines for preventive interventions. It pioneers the use of comprehensive literature reviews and publishes the first Guide to Clinical Preventive Services in 1989.


AHCPR (now AHRQ) launches a program to create evidence-based guidelines (1990-1996).

The Cochrane Collaboration creates a network of organizations from 13 countries, including the United States, to promote evidence-based health care though the production of systematic reviews and clinical guidelines (1993).

Funding for AHCPR operations is seriously threatened in response to lobbying by a small group of orthopedic surgeons angered by a Patient Outcomes Research Team report on the treatment of back pain (1995-1996).

Congress eliminates funding for the Office of Technology Assessment (1995).

AHRQ establishes the Evidence-based Practice Centers (EPCs) program to produce reports on clinical evidence and technology assessments (1997).

AHRQ, the American Medical Association, and the American Association of Health Plans (now America’s Health Insurance Plans) create the National Guideline Clearinghouse (1998).

Health plans, specialty societies, disease-based associations, and foundations create numerous programs that produce clinical guidelines.

The Centers for Medicare & Medicaid Services (CMS) establishes the Medicare Coverage Advisory Committee (now the Medicare Evidence Development and Coverage Advisory Committee) to provide objective assessments of the available evidence on the safety, efficacy, and clinical benefits of medical services or products for national coverage decisions (1998).

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