Evidence-Based Medicine and the Changing Nature of Health Care: 2007 IOM Annual Meeting Summary (2008)

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Appendix C IOM Roundtable on Evidence-Based Medicine Roster and Background Denis A. Cortese (Chair), President and CEO, Mayo Clinic Adam Bosworth, Founder President and CEO, Keas David R. Brennan, CEO, AstraZeneca PLC Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality Helen Darling, President, National Business Group on Health James A. Guest, President, Consumers Union George C. Halvorson, Chairman and CEO, Kaiser Permanente Carmen Hooker Odom, President, Milbank Memorial Fund Michael M. E. Johns, Chancellor, Emory University Michael J. Kussman, Undersecretary for Health, U.S. Department of Veterans Affairs Cato T. Laurencin, Professor, Chairman of Orthopedic Surgery, University of Virginia Stephen P. MacMillan, President and CEO, Stryker Mark B. McClellan, Director, Engelberg Center for Health Care Reform, The Brookings Institution Elizabeth G. Nabel, Director, National Heart, Lung, and Blood Institute Mary D. Naylor, Professor and Director of Center for Transitions in Health, University of Pennsylvania   The responsibility for the published Annual Meeting summary rests with the authors and the institution. IOM forums and roundtables do not issue, review, or approve individual documents. 187 

188 EVIDENCE-BASED MEDICINE Peter Neupert, Corporate Vice President, Health Solutions Group, Microsoft Corporation Nancy H. Nielsen, President-Elect, American Medical Association Jonathan B. Perlin, Chief Medical Officer and President, Clinical Services, HCA, Inc. Richard Platt, Professor and Chair, Harvard Medical School and Harvard Pilgrim Health Care John C. Rother, Group Executive Officer, AARP Tim Rothwell, Chairman, sanofi-aventis U.S. John W. Rowe, Professor, Mailman School of Public Health, Columbia University Donald M. Steinwachs, Professor, Bloomberg School of Public Health, Johns Hopkins University Andrew L. Stern, President, Service Employees International Union I. Steven Udvarhelyi, Senior Vice President and Chief Medical Officer, Independence Blue Cross Frances M. Visco, President, National Breast Cancer Coalition Kerry N. Weems, Acting Administrator, Centers for Medicare and Medicaid Services William C. Weldon, Chairman and CEO, Johnson & Johnson Janet Woodcock, Deputy Commissioner and Chief Medical Officer, Food and Drug Administration Roundtable Staff Katharine Bothner, Administrative Assistant Andrea Cohen, Financial Associate Molly Galvin, Consultant W. Alexander Goolsby, Program Officer J. Michael McGinnis, Senior Scholar and Executive Director LeighAnne Olsen, Program Officer Daniel O’Neill, Research Associate Roundtable Sponsors Agency for Healthcare Research and Quality, America’s Health Insurance Plans, AstraZeneca, Blue Shield of California Foundation, Burroughs Wellcome Fund, California Health Care Foundation, Centers for Medicare and Medicaid Services, Charina Endowment Fund, U.S. Department of Veterans Affairs, Food and Drug Administration, Johnson & Johnson, Moore Foundation, sanofi-aventis, Stryker. 

APPENDIX C 189 Institute of Medicine Roundtable on Evidence-Based Medicine Charter and Vision Statement The Institute of Medicine’s Roundtable on Evidence-Based Medicine has been convened to help transform the way evidence on clinical effectiveness is gener- ated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barri- ers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public-private cooperation for change. ****************************************** The Institute of Medicine’s Roundtable on Evidence-Based Medicine has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. We seek the develop- ment of a learning healthcare system that is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care. Vision:  Our vision is for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nation’s health. Goal:  By the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. We feel that this presents a tangible focus for progress toward our vision, that Americans ought to expect at least this level of perfor- mance, that it should be feasible with existing resources and emerging tools, and that measures can be developed to track and stimulate progress. Context:  As unprecedented developments in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented challenges to identify and deliver the care most appropriate for individual needs and conditions. Care that is important is often not delivered. Care that is delivered is often not important. In part, this is due to our failure to apply the evidence we have about the medical care that is most effective—a failure related to shortfalls in provider knowledge and accountability, inadequate care coordination and support, lack of insurance, poorly aligned payment incen- 

190 EVIDENCE-BASED MEDICINE tives, and misplaced patient expectations. Increasingly, it is also a result of our limited capacity for timely generation of evidence on the relative effectiveness, efficiency, and safety of available and emerging interventions. Improving the value of the return on our healthcare investment is a vital imperative that will require much greater capacity to evaluate high-priority clinical interventions, stronger links between clinical research and practice, and reorientation of the incentives to apply new insights. We must quicken our efforts to position evi- dence development and application as natural outgrowths of clinical care—to foster health care that learns. Approach:  The IOM Roundtable on Evidence-Based Medicine serves as a forum to facilitate the collaborative assessment and action around issues central to achieving the vision and goal stated. The challenges are myriad and include issues that must be addressed to improve evidence development, evi- dence application, and the capacity to advance progress on both dimensions. To address these challenges, as leaders in their fields, Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public–private cooperation for change. Activities include collaborative exploration of new and expedited a ­ pproaches to assessing the effectiveness of diagnostic and treatment interven- tions, better use of the patient care experience to generate evidence on effec- tiveness, identification of assessment priorities, and communication strategies to enhance provider and patient understanding and support for interventions proven to work best and deliver value in health care. Core concepts and principles: For the purpose of the Roundtable activi- ties, we define evidence-based medicine broadly to mean that, to the great- est extent possible, the decisions that shape the health and health care of Americans—by patients, providers, payers, and policy makers alike—will be grounded on a reliable evidence base, will account appropriately for individual variation in patient needs, and will support the generation of new insights on clinical effectiveness. Evidence is generally considered to be information from clinical experience that has met some established test of validity, and the appro- priate standard is determined according to the requirements of the intervention and clinical circumstance. Processes that involve the development and use of evidence should be accessible and transparent to all stakeholders. A common commitment to certain principles and priorities guides the activities of the Roundtable and its members, including the commitment to the right health care for each person; putting the best evidence into practice; establishing the effectiveness, efficiency, and safety of medical care delivered; building constant measurement into our healthcare investments; the estab- lishment of healthcare data as a public good; shared responsibility distrib- uted ­ equitably across stakeholders, both public and private; collaborative stakeholder involvement in priority setting; transparency in the execution of activities and reporting of results; and subjugation of individual political or stakeholder perspectives in favor of the common good.