Knowing What Works in Health Care: A Roadmap for the Nation

TABLE 3-6 Definitions of Commonly Used Priority Setting Criteria

Criterion	Definition
Disease burden	Extent of disability, morbidity, or mortality imposed by a condition, including effects on patients, families, communities, and society overall
Controversy	Controversy or uncertainty around the topic and supporting data
Cost	Economic cost associated with the condition, procedure, treatment, or technology related to the number of people needing care, unit cost of care, or indirect costs
New evidence	New evidence with the potential to change conclusions from prior assessments
Potential impact	Potential to improve health outcomes (morbidity, mortality) and quality of life; improve decision making for patient or provider
Public or provider interest	Consumers, patients, clinicians, payers, and others want an assessment to inform decision making
Sufficient evidence	The available research literature provides adequate evidence to support an assessment
Variation in care	Potential to reduce unexplained variations in prevention, diagnosis, or treatment; the current use is outside the parameters of clinical evidence

reviews focused primarily on pharmaceuticals (40 percent) and surgical procedures (16 percent) and overrepresented cerebrovascular disease, diabetes, breast cancer, and HIV/AIDS, whereas they underrepresented depression and bipolar disorder, injuries, and substance abuse disorders. Similarly, a survey of European horizon-scanning agencies found little evidence that the organizations had operationalized all of their selection criteria (Douw and Vondeling, 2006).

FINDINGS

There is little solid basis at present for judging whether one method of selecting priorities is better than another. The Cochrane Collaboration and the USPSTF are currently reconsidering their approaches and may have insights to offer in the future (Cochrane Collaboration, 2007; Guirguis-Blake et al., 2007). Although AHRQ has handled a relatively small volume of nominations, it has considerable experience managing topic nominations for its effectiveness programs. The Program should learn from this experience.

New and emerging technologies are clearly high priorities for health

Table of Contents

Front Matter R1-R22

Summary 1-16

1 Introduction 17-32

2 An Imperative for Change 33-56

3 Setting Priorities for Evidence Assessment 57-80

4 Systematic Reviews: The Central Link Between Evidence and Clinical Decision Making 81-120

5 Developing Trusted Clinical Practice Guidelines 121-152

6 Building a Foundation for Knowing What Works in Health Care 153-178

Appendix A: Acronyms and Abbreviations 179-180

Appendix B: Workshop Agendas and Questions to Panelists 181-192

Appendix C: Template for Submissions of Topics to the Agency for Healthcare Research and Quality 193-198

Appendix D: Standards for Reporting Meta-Analyses of Clinical Trials and Observational Studies: QUOROM and MOOSE 199-204

Appendix E: Examples of ECRI Institute and Hayes, Inc., Quick Turnaround Reports 205-230

Appendix F: Guideline Standards: The AGREE Instrument and COGS Checklist 231-236

Appendix G: Committee Biographies 237-246

Index 247-256

FINDINGS