• Developing effective coordination and collaboration be­tween U.S. and international partners;

  • Developing a process to ensure that standards for SRs of CER are regularly updated to reflect current best practice; and

  • Using SRs to inform priorities and methods for primary CER.

This recommendation conveys the committee’s view of how best to implement its recommendations to improve the science and support the environment for SRs of CER, which is clearly in the public’s interest. PCORI is specifically named because of its statutory mandate to establish and carry out a CER research agenda. As noted above, it is charged with creating a methodology committee that will work to develop and improve the science and methods of SRs of CER and to update such standards regularly. PCORI is also required to assist the Comptroller General in reviewing and reporting on compliance with its research standards, the methods used to disseminate research findings, the types of training conducted and supported in CER, as well as the extent to which CER research findings are used by healthcare decision makers. The HHS agencies are specifically named because AHRQ, NIH, the Centers for Disease Control and Prevention, and other divisions of HHS are major funders and producers of SRs. In particular, the AHRQ Effective Health Care Program has been actively engaged in coordinating high-quality SRs and developing SR methodology. The committee assigns these groups with responsibility and accountability for coordinating and moving the agenda ahead.

The committee found compelling evidence that having high-quality SRs based on rigorous standards is a topic of international concern, and that individual colleagues, professional organizations, and publicly funded agencies in other countries make up a large proportion of the world’s expertise on the topic. Nonetheless, the committee necessarily follows the U.S. law that facilitated this report, which suggests a management approach appropriate to the U.S. environment is useful. A successful implementation of our final recommendation should result in a U.S. enterprise that participates fully and harmonizes with the international development of SRs, serving in some cases in a primary role and in others as a facilitator or participant. The new enterprise should also fully understand that this cannot be entirely scripted and managed in advance—structures and processes must allow for innovation to arise naturally from among U.S. individuals and organizations already fully engaged in the topic.

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