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OCR for page 61
A
Clinical Conditions ant:] Medical
Technologies Consirlere(1 by the
Priority-Setting Group
The folBowing list of candidate assessment topics was compiled from
the sources descnbed in Appendix C. Each candidate topic was classified
under the appropriate clinical condition or technology group (noted as the
main entry in Tables A.l and A.2~. Suggested technologies that may be
used for the prevention, screening, diagnosis, or treatment of a clinical
condition are listed under that condition in Table A. 1. Technologies mat
may be used for many cI=cal conditions are listed as separate cross-
cutt~ng technologies in Table A.2. A total of 496 candidate topics were
considered. These are broken down into 73 groups of conical conditions
and associated technologies Table A.1) and 36 groups of other technolo-
gies (Table A.21. The technologies considered for each clinical condition
are neither mutually exclusive nor exhaustive, but represent the topics
suggested by the source organizations. The management option of using
no technology is understood to be included under each clerical condition.
The nomenclature for technologies is as follows:
T
prey.
T
T
Dx-
T -
~Rz.
*
{}
Technology for prevention.
Technology for screening.
Technology for diagnosis.
Technology for treatment.
Indicates that the technology is listed under more than
one clinical condition.
Indicates that the listed clinical states were considered
under that clinical condition.
61
OCR for page 62
62
NATIONAL ASSESSMENT PR[ORmES
TABLE A.1 Candidate Clinical Conditions and Associated Technologies
Abdominal pain
Te
DX
T
DX
T .
ADX
Adult gastroententis
Adult pneumonia
Alzheimer's disease
Aphasia
Bladder cancer
T
screcJl. Do
T
~Dx-
T
DX
Breast cancer
T :
screen
T
5~7CCH, DX
T
*z
T
Rx.
T
Rx.
computed tomography [Cl ]*
laparoscopy*
ultrasound*
cystourethroscopy
cystoscopy with biopsy
urine cytology
screening programs
mammography
hormonal therapy*
excision of breast cyst or lesion
mastectomy
Cardiac arrhythmias
{bradycardia' conduction defects, tachycardia}
T*x: antiarrhythmic drugs
T*x: pacemakers and related procedures
TRX catheter ablation techniques
T*x: implantable cardiac defibrillatory*
Cataracts
T
RX
T
RX
T
RX
surgical cataract removal
lens laser surgery
intraocular lens implant
Cerebrovascular accident
Cervical cancer
T,c,~" screening programs
Chronic fever
Chronic obstructive pulmonary disease
{adult asthma, adult bronchitis }
TD~: pulmonary function tests*
Table A.] continues
OCR for page 63
APPENDIX A
TABLE A.1 (Continued
63
T.
Rx
T
R~:-
T -
~Rx.
Coronary artery disease
T:
prey
T
~ prey.
T :
Screen
T
~crre~l ~
T
Ax
T
Dx.
T
Dx
T
ADD.
T -
~Dx.
T
Dx
r ~
Dx
T
Dz-
T
1Dz.
T
Rx-
T -
~Rx
T
Rx.
T ~
1Rz.
T -
'Rx.
oxygen therapy*
ventilator therapy
physical therapy
{acute myocardial infarction, angina pectorals,
chest pain, ischemic heart disease ~
cholesterol-controHing drugs and programs
· ~
aspirin
cholesterol screening*
genetic screening*
imaging modalities (angio, cine-CI, magnetic
resonance imaging [MRIl, positron-emission
tomography [PETE*
ultrasound modalities (e.g., Doppler echo-
cardiography)*
stress or exercise tests
monoclonal antibodies*
other cardiac functional tests
cardiac catheterization
electrocardiography [EKG]*
continuous EKG (Holler monitoring)
ombolytic agents and therapy (e.g., :-PA (tissue-
plasminogen activator), streptokinase)
percutaneous coronary angioplasty
percutaneous transluminal atherectomy*
coronary artery bypass graft surgery
other drug therapy
cardiac rehabilitation programs
Cystitis
Destructive behavior in developmental disabilities
Diabetes mellitus
{diabetic retinopathy}
T
~ be, - a, D~.
T
~ secrecy, Dx-
T
Rx-
T
Rx-
blood glucose tests and monitors*
preoperative evaluation of diabetic cardiac surgical
patients
blood glucose control devices
implantable insulin pumps*
Table A.] continues
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64
TABLE A.1 (Continued
NAT70NAL ASSESSMENT PRIORITIES
Disseminated neoplastic disease
TRX chemotherapy*
TRY: bone marrow transplantation*
Diverticular disease
Encephalopathy
T
*.r
T
Rat
T .
TRY
Epilepsy
T ~
~Rx.
T -
~ R.~.
{coma}
Fecal incontinence
T
Ret
Gallbladder disease
{gallstones, cholelithiasis, cholecystitis3
T
ADA
T
1Dz
T
ADA
T
Rx-
T
Ret
T
Rx.
T
Rx-
T
Rx.
T
Rx-
standard life support
drug therapy
hypothermia
surgery
dmg therapy
surgical procedures
.
Gastrointestinal bleeding
T
sconce
T~creca
T
arts
T
ADA
T
Dot
oral cholecystogram
nuclear radioisotope scan
imaging technologies (e.g., ultrasound)*
cholecystectomy and other hepatobilia~y procedures
(e.g., cholangiography)
li~otnpsy*
stone dissolution Snags and agents
endoscopic interventions (e.g., papillotomy)
laser ablation*
other drug therapy
{bleeding peptic ulcers*, colorectal cancer' diverticulosis,
esophageal cancer, hemorrhoids, upper gastrointestinal
bleeding, rectal bleeding, stomach cancers
colorectal cancer screening (e.g., fecal occult blood
testing)
colonoscopy
upper gastrointestinal (GI) endoscopy
colonoscopy win biopsy
upper GI endoscopy with biopsy
-
Table A.] continues
OCR for page 65
APPENDIX
TABLE A.1 (Conanue~
65
T
D~
T .
~ *~.
T
RS
T
Rx.
T ~
~Rs.
Glaucoma
T
Rx
Headache
Head injur
T
ADX
Hearing loss
T
DS
T
Rx-
T -
'Rs.
Heart fa~lure
T
Rx.
T
T
Rx.
Hemoptysis
sigmoi do s copy
~ennal cautery (e.g., laser endoscopic elec~o-
coaguladon)*
sclerosing agents
colonoscopy with polypectomy
colectomy
laser trabeculoplasty*
imaging modalities (e.g., CI~, MRI)*
audiometry tests (e.g., tympanometry)
cochlear implants*
bone conduction hearing devices
heart transplantation*
ardficial hearts*
cardiopulmona~y resuscitation
{lung cancer, pulmonary embolus}
TD~ bronchoscopy
T
D~
T .
AD~
T
DS
T
DS
Hern~as
TRS SUrg1C~j1 inguinal repa~r
Human immunodeficiency v~rus (HIV) infection
{acquired immune deficiency syndrome [AIDS]
Tp~: infecdous control programs for AIDS
T~D~ H]tiVv~ drugs (e g., zidovudine [AZr])
spu~n cytology
imag~ng modalities (e.g., chest cr, MRI)*
mediastinoscopy wi~ node biopsy
~oracotomy wi~ node biopsy
Hypertension
Table A.] con~inues
OCR for page 66
66
TABLE A.1 (Continued
NATIONAL ASSESSMENT PRIORITIES
Impotence
TRX penile prosthesis
Incontinence
TDS urodynamic studies
Tic: incontinence devices
TRX artificial urinary sphincter
Infectious disease diagnosis
Infertility
T .
'DX-
T
Rx
T
'Rx
laparoscopy*
in vitro fertilization procedures
vaginal probe-directed egg retrieval
Joint disease & injury
arthritis, degenerative joint disease, health impact of jog-
ging, knee problems, rheumatoid arthritis, sports injures)
T : blood level of keratan sulfate in osteoarthritis
·C,C£A
T : genetic markers for rheumatoid arthritis
5C'CCA
TDX arthroscopy
TED: imaging modalities (e.g., x ray, CI, MRI)*
TRX orthopedic prostheses* (e.g., total knee and/or hip-
replacements)
T
Rx
T -
~Rx.
T
RX
T
Rx
Kidney stones
T
Rx.
Leukemia
Low back pain
viscoelastic joint fluid replacement
radiation synovectomy for rheumatoid arthritis
meniscectomy
other joint surgery
lithotnpsy*
{chronic medical back problems, medical back problems,
herniated lumbar disks, low backache ~
TDX imaging modalities (x ray, CI, MRI)*
TRX rest andlor exercise
TRX percutaneous lumbar diskectomy
TRX chemical degradation of herniated disks (e.g., win
chymopapain)
T*x: musculoskeleta] manipulations
Table A.] continues
OCR for page 67
APPENDIX A
TABLE A.1 (Continued
67
T'r: laminectomy
TRX traction
T
RX
T
Ri.
pain therapies (e.g., epidural and intraligamentous
injections)
other medical and drug therapy (both outpatient and
inpatient)
Lyme disease
Obesity
Oral complications of cancer treatment
Osteoporosis
t hip fracture}
T .
prep
T
~ ~ .
T :
screc`I
Parkinson's disease
Pediatnc ear infection
hormonal therapy*
blood test for level of interieukin ~
bone densitometry (e.g., dual-photon abso~ptiometry)*
TRX: middle ear tube drainage
TR.X antibiotic therapy
Pediatnc gastroententis
Pediatnc hyperactivity
Pediatnc respiratory disease
Pediatric asthma, pediatric bronchitis, pediatric pneumonias,
respiratory distress syndrome]
Peptic ulcer disease*
T : antiuicer drugs
pack
Penpheral vascular disease
{aortic aneurysms; stenosis/occlusion of precerebral, renal,
femoral artenes; deep vein ~mbophlebitis;
pulmonary embolus)
TDX digital subtraction angiography
TED: Doppler ultrasound (e.g., carotid and other peripheral
vessels)*
extracranial vascular procedures
percutaneous ~nsluminal angioplasty *
percutaneous transluminal atherectomy*
laser atherectomy*
T
Rz-
T .
~R,-
T
*x
T
RX
-
Table A.] continues
OCR for page 68
68
TABLE A.1 (Continued
NATIONAL ASSESSMENT PRIORITIES
T
*x
T
Rx
Pregnancy
T:
prey
T
prey
T :
5c,££J!
T
Dx.
T
~Dx.
T
Dx
T
'Dx-
T
Dx.
T
~Dx.
T
Rs
T
firs
T
firs
T
Rs
T
ARM
Prostatism
Psoriasis
Psychiatric Disorders
T.
T -
'R.~-
T
Rs
surgical ~}omboendarterectomy (e.g., carotid
vertebral, aortic)
surgical aneurysm repair
{uncomplicated pregnancy, high-nsk pregnancy,
low-birthweight infants)
prenatal care and education programs
prenatal genetic counseling
prenatal laboratory testing and screening (e.g., alpha-
fetoprotein testing)
ultrasound*
chononic vilBus sampling
amniocentesis
fetal monitoring
in utero genetic evaluation*
flow cytometry
natural vaginal delivery
electronically monitored vaginal delivers,
forceps vaginal delivery
cesarean section
neonatal intensive care*
{prostatic hype~plasia~ypertrophy}
open prostatectomy
transurethral prostatectomy
"watchful waiting"
{anxiety states, depressive neurosis, depressive states
disorders, eating disorders (e.g., anorexia, bulimia),
psychosis, schizophrenia, sleep disorders in the elderly}
psychotropic drugs
psychotherapy
psychosurger,
Table A.] continues
OCR for page 69
APPENDIX A
TABLE A.1 (Continued
69
Pyelonephritis
Renal failure
TRX hemodialysis
TRX e~h~poietin*
Respiratory failure
Scoliosis
TRX surgery and fixation
TRX bracing
TRX electromagnetic shmulation
Skin effects of sunlight and ultraviolet radiation
Spinal cord injuries
TRX long-tenn rehabilitation programs
Stroke
{cerebrovascular accident)
Substance abuse
~ alcohol and drug abuse]
Tprev: public education and prevention programs
Sudden infant death syndrome
Tprc,: sleep apnea mo~tonng
Surgical blood loss
TRX autotransfusion
TRX homologous transfusion
TRX hemodilution
Surgical infection
T
pace
T -
ARX
.
preoperative antibiotic therapy
postoperative antibiotic therapy
Throat infection
TD3[ thmat culture*
TR,` antibiotics
Tonsillitis/Adenoiditis
TRX antibiotic therapy
TRX surgery (e.g., tonsillectomy)
Table A.] continues
OCR for page 70
70
TABLE A.1 (Continued
NATIONAL ASSESSMJENTPRlORlTlES
. .
Transient ischemic attack
Utenne bleeding
{uterine cancer)
—
TDX pe .VlsCOpy
TDX hysteroscopy
TRX laser ablation of endometnal tissue*
TRY: hysterectomy
TRY honnonal therapy*
TRY: dilatation and curettage
Valvular heart disease
TRX valvuloplasty and other surgical cardiac valve
procedures
TRX percutaneous balloon valvuloplasty
Weight loss
OCR for page 71
APPENDIX A
TABLE A.2 Other Candidate Technologies
71
Acupuncture
Acyclovir
Biofeedback
Blood donor screening programs
Chelation therapy
Dermatological technologies
Drug: topical cor~costeroids
Procedure: skin biopsy
Procedure:
Procedure:
Procedure:
acne surgery
excision of cyst
destruction of skin lesion
Diagnostic and therapeutic immuno/genetic technologies
Drug: monoclonal antibodies*
Drug: antitumor vaccines
Drug: immune agents (e.g., interleukin, interferon)
Procedure: viral infection screening tests
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
genetic tests & probes
DNA recombinant techniques
in utero genetic evaluation*
genetic screening in adults (e.g., Huntington's
chores, coronary artery disease*)
immunocytochemistry tests
other genetic engineering technologies
human gene therapy
plasmapheresis
allergy testing & therapy
other immunotherapy
Diagnostic imaging technologies
Drug: low osmolality and other imaging contrast
agents
Drug: radiopharmaceuticals
Device/procedure: x ray (including dental x rays)*
Device/procedure: CI and related technologies (e.g., cine-CI)*
Device/procedure: MR] and related technologies (e.g., gating
devices)*
Device/procedure: PHIL*
Device/procedure: single photon emission CT [SPECr]
Table A.2 continues
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72
TABLE A.2 (Continued
NYLONS MS=SM~PHOR=ES
Device/procedure: ultrasound (e.g., endovaginal, transrectal,
endoscopic)*
Device/procedure: echocardiography (e.g., heart, carotid
artenes)*
Device/procedure: dual-photon abso~tiometry*
Device/procedure: Oceanography
Device/procedure: microwave tomography
Support system: picture archiving and communication systems
Support system: teleradiology systems
Diagnostic laboratory testing
Device: automated clinical analyzers
Device: diagnostic kits.
Procedure: blood lipoprotein evaluation
Procedure: other blood tests*
Procedure:
Procedure:
Procedure:
Procedure:
Drug delivery systems
Device:
Device:
urinalysis
throat culture*
human papillomavirus testing
other laboratory tests*
vascular access device
infusion pumps (e.g., implantable insulin
pumps)*
Procedure: patient~ontrolled analgesia
Procedure: parenteral nutntion*
Procedure: home intravenous therapy*
Erythropoiedn
Growth hormone
Home health care technologies
Drug: metabolic and nutrient agents (e.g., parenteral
nutntion)*
Device:
Device:
Device:
Device:
Device:
Procedure:
beds (e.g., electric, flotation)
home diagnostic kits*
device to prevent pressure sores
home monitoring equipment (e.g., EKG, fetal
monitors and pediatric apnea monitors)
home alarm systems
home respiratory therapy (e.g., oxygen*,
ventilator therapy*)
Table A.2 continues
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APPENDIX ~
TABLE A.2 (Continued
73
home intravenous therapy*
Procedure:
hoplantable devices
Device:
Device:
Device:
Device: implantable bone growth stimulators*
Device: implantable cardiac defibriBators*
Intensive care units DCU)
Support system: medical ICU
Support system: surgical ICU
Support system: coronary ICU
Support system: neonatal ICU*
Laser technologies
Device:
Device:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
Procedure:
cochIear implants*
implantable infusion pumps (e.g., insulin)*
pacemakers*
endoscopic lasers*
dye lasers
palliative treaunent of recap cancer
gallstone, kidney stone ablation*
bone fracture repair
peripheral nerve microsurgery
ablation of endometnal tissue*
nenre ablation for menstrual pain
neurosurgery applications
photocoagulation of the retina*
laser atherectomy*
laser trabeculoplasty*
Neonatal circumcision
Neonatal extraco~poreal membrane oxygenation
Neoplastic technologies
Drug: tumor markers
Procedure: chemotherapy*
Procedure: radiation and photoradiation therapy
P~oce~iure: tumor~irected therapy
Procedure: hypenhem~ia
Neurological technologies
Procetlure: electroencephalogram [EEG] monitonng*
Procedure: nerve conduction studies
P~cedure: peripheral nerve ultrasound
P~dure: elec~s~dmulabon of salivary production
Table A.2 continues
OCR for page 74
14
TABLE A.2 (Continued
NA TI ONAL ASSESSMENT PRI ORI TIES
Operating room and other Wonton technologies
Device:
_ _ _ = _ _ _ _ c~ _
oxygen analyzers
Device/procedure: cardiac output monitoring (e.g., electrical
bioimpedance)
Device/procedure: blood pressure monitoring
Device/procedure: apnea monitoring*
Device/procedure: carbon dioxide monitoring
Device/procedure: EKG monitonng*
Device/procedure: mass spectroscopy
Device/procedure: BEG monitonng* (e.g., continuous, video)
Device/procedure: pulse oximet~
Device/procedure: ventilator alann systems
Organ transplantation and replacement
Device/procedure: orthopedic prostheses*
Device/procedure: heart (e.g., transplantation, artificial)*
Device/procedure: kidney (e.g., transplantation, dialysis)
Device/procedure: ligaments (e.g., transplantation, artificial)
Device/procedure: pancreas (e.g., transplantation, artificial)
Procedure: bone graft surgery
Procedure: bone marrow transplantation*
Procedure: liver transplantation
Procedure: lung transplantation
Procedure: intestine transplantation
Procedure: other tissue transplantation (e.g., brain, fetal,
endocnne)
Organizational systems for health care
Org. system: improved health status measures for
quality of care
improved medical criteria for preadmission
Org. system:
review and discharge planning
Org. system: strategies for changing physician behavior
Org. system: third-party coverage of Drugs (e.g., nordabeled
uses, investigational new drugs)
Org. system: risk adjustment and quality assurance
Org. system: ergonomic research in industrial accident
prevention
Table A.2 continues
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APPE:[JDIX A
TABLE A.2 (Continued
75
Other gastrointestinal technologies
Device: gastroesophageal device
Device: gastric bubble
Procedure: percutaneous gastrostomy
Procedure: colonic irrigation
Other musculoskeletal technologies
Drug: heterotropic bone factor
Drug: hydroxyapatite and other bone substitutes
Device: bone growth stimulators* (e.g., for spinal
surgery)
Other ophthalmologic technologies
Procedure: glare testing and contrast sensitivity
Procedure:
Procedure:
Other surgical technologies
Procedure:
Procedure:
Procedure:
Procedure:
refractive keratoplasty
laser photocoagulation of the retina*
back and neck surgery
fetal surgery
liposuction surged
temporomandibular surgery
Procedure: tissue expansion surged
Patient care information systems
Device:
Device:
Support system:
Support system:
Support system:
Support system:
Support system:
Pediatric urethral dilatation
Periodic health exam~nabon
Physical therapy
Procedure:
Procedure:
Preoperative evaluation
Device:
bedside computer tennis
bar code readers (e.g., medical record, x ray
retrieval)
data input and storage
electronic image transmission and storage
computer techniques in medical diagnosis and
management
automated patient record systems
expert systems in medical diagnosis
kinetic therapy
medical therapy
automatic preoperative test selection device
other modes of preoperative evaluation
Table A.2 continues
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76
TABLE A.2 (Continued
NATIONAL ASSESSMENT PRIORITIES
Respiratory Technologies
Device: ventilators
Procedure: pulmonary function tests*
Procedure: bronchospasm evaluation
Procedure: spirometry
Procedure: respiratory therapy* (e.g., intermittent positive
pressure)
oxygen therapy* (e.g., hyperbaric)
Ribavirin
Technologies for the handicapped
Device: low-vision aids
Device: other communication aids
Device: robotic aids
Device: walking aids
Device: wheelchairs
Device: other mechanized vehicles
Therapeutic radiologic procedures
Procedure:
Procedure: abscess drainage
Procedure: cyst puncture
Procedure: percutaneous transluminal angioplasty*
Procedure: litho~ipsy (renal, biliary)*
Representative terms from entire chapter:
imaging modalities
