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SConclusions ant} Recommend ations The Institute of Medicine and its Council on Health Care Technology hope to accomplish three goals through this pnon~-setting pilot exercise. The first goal is to can attention to the need for assessments in the 20 high-pnonty clinical condition and technology areas descnbed in this report Assessment programs, and the organizations and agencies in the private and public sectors that fund assessments, are encouraged to direct their efforts to these priority areas. These priorities should help rational- ize the expenditure of existing resources and serve to justify the commit- ment of new resources where funding gaps can be demonstrated. The second goal is to generate a much broader discussion about na- tional pnor~ty-setting by making explicit the process used in this exercise. The participants, We methodologies used, and the criteria employed are all important determinants of the priorities chosen. This project demon- strates an accountable national pnonty-setting process that recognizes the pluralistic assessment needs of the different health care sectors. The pnonty-sefflng cr~tena and the approach used here to identify priority topics reflect broad assessment interests. The selection of nationally applicable criteria considered those criteria used by major health care organizations. The clinical condition and technology approaches used to identify candidate priorities accommodate the different manners in which questions about assessing medical practice anse. Users of such a set of pr~onties need to understand these elements in order to judge the applica- bility of the priorities for their own purposes. A foBow-up effort to reexamine the process used in this pilot effort would serve to improve its 57

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58 NATIONAL ASSESSMENT PRlORITlES Validity, enhance its national acceptance, and assist in adapting it to the specific needs of the vaned groups involved in pnonty-seHing. Finally, the Institute of Medicine seeks to can attention to establishing a mechanism to ensure that national pnonty-setting for medical practice and technology assessment is cattier on continuously. This is necessary, given the new infonnation about health status and health costs, new or emerging technologies, established technologies with different applica- tions, and changing medical practice patterns. Once chosen, pnondes must be refined to reflect the current infonnation and updated accord- ingly. Priorities must be modified as some questions are answered, or found to be unanswerable, and other questions emerge Mat are more passing or more ready for resolution. Continuity, methodologic rigor, and broadly based input win be necessary if this process is to be bow timely and credible. A stable, permanent structure may be needed to Fife these goals. There is an undeniable need for setting national priorities for Be assessment of clinical conditions and medical technologies. It is a need that win not be met by a single exercise, meeting, or publication. This effort is the first step toward demonstrating a national pnonty-setting process for medical practice and technology assessment.