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Knowing what Works in Health Care: A Roadmap for the Nation
determination (e.g., are insulin pumps covered?) or a more narrow assessment to identify the subpopulations for which a service should be covered (e.g., who among the population is likely to benefit from an artificial disc for degenerative disc disease?). If the topic in question is not within the boundaries of covered benefits, payers are unlikely to assess it. Thus, for example, an insurance company is not likely to assess the efficacy of a vaccine if it does not cover preventive services.
The agenda of AHRQ, the lead federal health agency charged with conducting systematic reviews of clinical effectiveness, is circumscribed by statute. The Effective Health Care Program, for example, may only sponsor studies related to 1 of 10 priority conditions established by the secretary of the U.S. Department of Health and Human Services (Table 3-2). The U.S. Preventive Services Task Force (USPSTF) focuses on clinical preventive services provided in primary care settings. Many medical professional societies assess evidence to develop clinical guidelines for the management of specific conditions. Manufacturers assess evidence to demonstrate safety and efficacy and to persuade payers and other constituencies of their value. Private research firms generally focus on responding to marketplace demands.
The Cochrane Collaboration supports the broadest range of evidence reviews worldwide; its volunteer researchers participate in 51 discipline-specific (e.g., musculoskeletal) review groups that set their own agendas in accord with the important questions within their disciplines. The Cochrane Collaboration’s Steering Group is considering new approaches to how the review groups set priorities for their research and has funded research projects whose results will guide them in this effort (Cochrane Collaboration, 2007).
Methods Used to Identify Potential Topics
Some organizations, including AHRQ and the USPSTF, actively solicit nominations from stakeholders and the public (Table 3-2). Other organizations have internal processes for gathering suggestions from staff or outside advisors.
The response to the AHRQ open call for topics is of interest, although it is not necessarily indicative of the potential response to a broader call for topics from a well-funded agency. Table 3-3 shows the number of EPC topics nominated and funded, the topic areas, and the types of organizations that nominated a topic for the EPC program during 2005 and 2006. The total number of nominations was small. From 2005 to 2006, AHRQ received 76 topic nominations: 36 were related to treatment effectiveness; 13 were related to diagnostic interventions; and the rest concerned quality improvement and patient safety, prevention, organization and finance, and other topics. Ultimately, 51 percent of the topics were funded.