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Introduction Group judgment methods are perhaps the most widely used means of assessment of medical technologies in many countries. The con- sensus development conference is a relatively inexpensive and rapid mechanism for the consideration and evaluation of different attri- butes of a medical technology including, for example, safety, eff~- cacy, and efficiency, among many others. The current concept of the consensus development program originated at the National Insti- tutes of Health (NIH) in the United States. The first conference was held in the United States in 1977 as part of an effort to improve the translation of NIH biomedical research findings for use in clinical practice. Since that time, the methods of conference organization and conduct, as well as dissemination strategies for the results, have evolved in the attempt to refine the U.S. process. Many countries have initiated their own consensus development programs. Although the idea of consensus development is common to all programs, the consensus development process and dissemination mechanisms dif- fer across countries. Individuals in a variety of countries have re- modeled the NIH consensus development conference methodology to adapt the technological assessment to the particular national con- text of the program. The Methods Panel of the Council on Health Care Technology initiated a project to compare and contrast international consensus development programs in order to share the cumulative insight and

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2 CONSENSUS DEVELOPMENT experience gained in the different countries. The goal of the work- shop was to examine existing programs and to formulate suggestions for improvements in the use of the group judgment methodology. Individuals in the field of consensus development from eleven coun- tries gathered for one day to work toward improved consensus de- velopment conferences and mechanisms to translate these findings into better patient care. Before the workshop, individuals developed written profiles of nine consensus development programs in eight countries, including Canada (two programs), Denmark, Finland, The Netherlands, Nor- way, Sweden, the United Kingdom, and the United States. For each profile, authors considered the national context of the program, the scope of the program, the format and conduct of the consensus con- ferences, the documentation and use of evidence in the process, and the dissemination and impact of consensus recommendations. Work- shop participants received copies of these profiles in preparation for the workshop. The final versions of the profiles are included in the first part of this report. Workshop discussion was based upon five major presentations. Using material provided in the program profiles and other resources, each main presenter provided an examination of one particular as- pect of consensus development across the different countries. Speak- ers presented papers on the role and sponsorship of consensus devel- opment programs in national health care systems, the topic and scope of the programs, the documentation and use of evidence in the con- sensus development processes, the format and conduct of consensus development processes, and the dissemination and impact of consen- sus development exercises. At the end of the workshop, a working group met to formulate recommendations for improving consensus development for assess- ing health technologies. The working group attempted to address the issues raised in the discussions and to record the solutions devel- oped by participants in the workshop. The recommendations may require adaptation to the different national contexts of the programs in order to improve the quality and impact of international consen- sus development programs. These recommendations represent the consolidated view of the writing group and are not necessarily the views of the National Academy of Sciences or any of its constituent parts, the U.S. Department of Health and Human Services, or the or- ganizations with which the authors are affiliated. These recommen-

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INTRODUCTION 3 cations may serve as a useful guide for improving consensus devel- opment programs- or developing new programs. The five major presentation papers that address different aspects of the consensus development programs are included in the first section of this report. The program profiles are provided in alpha- betical order by country in the second section. The recomm'enda- tions of the working group follow these sections. An international consensus development bibliography is provided to facilitate further research on consensus development. The articles contained in the bibliography are specifically oriented toward consensus development; therefore, some of the references used in the papers in this report that do not directly address consensus development have been omit- ted. The bibliography includes additional articles on consensus development that were not cited by any of the report authors. A list of authors is provided in the final section of the report.

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Elements of the Consensus Development Process

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