Cover Image

PAPERBACK
$15.00



View/Hide Left Panel
Click for next page ( R2


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
Improving Consensus Development for Health Technology Assessment: An International Perspective Clifford Goodman and Sharon R. Baratz, editors Council on Health Care Technology Institute of Medicine National Academy Press Washington, D.C. 1990

OCR for page R1
The INSTITUTE OF MEDICINE was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters per- taining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identi- fying issues of medical care, research, and education. The COUNCIL ON HEALTH CARE TECHNOLOGY was estab- lished in 1986 by the Institute of Medicine as a public-private entity to address issues of health care technology and technology assess- ment. The council is committed to the well-being of patients as the fundamental purpose of technology assessment. In pursuing that goal, the council draws on the services of experts in medicine, health policy, science, engineering, and industry. The Council on Health Care Technology sponsored a workshop on International Consensus Development for Medical Technology Assessment in London on June 7, 1989. The workshop and these proceedings were supported in part by the National Center for Health Services Research and Health Care Technology Assessment, grant number HS 05526. The opinions and conclusions expressed here are those of the authors and do not necessarily represent 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 organiza- tions with which the authors are affiliated. Library of Congress Catalog Card Number: 90-60936 International Standard Book Number: 0-309-04239-9 Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue, NW Washington, DC 20418 Printed in the United States of America S127

OCR for page R1
Acknowledgments Among the various authors, reactors, and other participants, rep- resentatives of 11 countries contributed to this effort. The editors wish to thank the authors of the consensus program profiles and the authors and presenters of the five main workshop papers, whose names are given with their respective contributions to this publica- tion. The profiles were done well in advance of the workshop and formed much of the basis for the papers presented there. The five main papers constituted largely original work and provided the nec- essary multinational perspective. Important insight was provided by the reactors designated for the main presentations, including Bj0rn Backe, Anton Casparie, lohan Calitorp, Richard Chrzanowski, Gil Hill, Dominique Jolly, Egon Jonsson, lard Kankaanpaa, Anna-L`iisa Kauppila, Nick Klazinga, Jonathan Lomas, Duncan Neuhauser, and I.~.E. van Everdingen. Bryan Jennet gave a thoughtful and stimulating welcome to the work- shop. Itzhak Jacoby was instrumental in helping to plan the work- shop agenda. Based on the workshop deliberations, the writing group of 10 people from five countries drafted, reviewed, and edited mul- tiple versions of the recommendations included here for improving consensus development efforts. We gratefully acknowledge the assistance of the King's Fund Centre for hosting the workshop and wish to thank in particular Barbara Stocking, Jackie Spiby, and Maria Said. Holly Dawkins and Evan- . . . 111

OCR for page R1
iv ACKNOW~:DGMENTS son Joseph of the Institute of Medicine staff were most helpful with logistical arrangements and related support. Partial support for this project was provided by grant HS 05526 from the National Center for Health Services Research and Health Care Technology Assess- ment.

OCR for page R1
COUNCIL ON HEALTH CARE TECHNOLOGY Chair WILLIAM N. HUBBARD, JR. Former President The Upjohn Company Co-Chair JEREMIAH A. BARONDESS Professor of Clinical Medicine Cornell University Medical College HERBERT L. ABRAMS Professor of Radiology Stanford University School of Medicine RICHARD E. BEHRMAN Managing Director Center for the Future of Children The David and Lucile Packard Foundation PAUL A. EBERT Director American College of Surgeons PAUL S. ENTMACHER Senior Adviser, Medical Policy Metropolitan Life Insurance Company MELVIN A. GLASSER Director Health Security Action Council BEN L. HOLMES Vice President/General Manager Medical Products Group Hewlett-Packard Company GERALD D. LAUBACH President Pfizer, Inc. v WALTER B. MAHER Director Federal Relations Human Resources Office Chrysler Motor Corporation WAYNE R. MOON Executive Vice President & Operations Manager Kaiser Foundation Health Plan, Inc. LAWRENCE C. MORRIS, JR. Consultant in Health Care Financing and Former Senior Vice President Health Benefits Management Blue Cross and Blue Shield Association FREDERICK MOSTELLER Roger I. Lee Professor Emeritus Director Technology Assessment Program School of Public Health Harvard University MARY O. MUNDINGER Dean, School of Nursing Columbia University ANNE A. SCITOVSKY Chief, Health Economics Department Palo Alto Medical Foundation GAIL L. WARDEN President and Chief Executive Officer Henry Ford Health Care Corporation

OCR for page R1

OCR for page R1
Preface Recently, in many countries, the interests of different groups con- cerned with health care have focused on the use of medical tech- nologiestheir safety, efficacy, and effectiveness; their cost-effec- tiveness and cost-benefit; their impacts on quality of care; and their social, legal, and ethical implications. The sum of these varied interests comprises the field of health care technology assessment. The Council on Health Care Technology was created in the United States to promote the development and application of technology assessment in health care and the review of health care technologies for their appropriate use. The council was established as a public- private enterprise at the Institute of Medicine, a component of the National Academy of Sciences, through the Health Promotion and Disease Prevention Amendments of l9X4 (P.L. 98-551, later amended by P.L. 99-1171. In 1987 the U.S. Congress extended support for the council as a public-private venture for an additional three years (by P.L. 100-177). The goals and objectives of the council, as stated in the report of its first two years of operations, are "to promote the development and application of technology assessment in medicine and to review medical technologies for their appropriate use. The council is guided in its efforts by the belief that the fundamental purpose of technol- ogy assessment is to improve patient well-being and the quality of . ~ V11

OCR for page R1
~ V111 PREFACE care." In pursuing these goals, the council seeks to improve the use of medical technology by developing and evaluating the measure- ment criteria and the methods used for assessment, to promote edu- cation and training in assessment methods, and to provide technical assistance in the use of data from published assessments. The council has conducted its activities through several panels and committees. Members of these groups reflect a broad set of interested constituencies physicians and other health professionals, patients and their families, payers for care, biomedical and health services researchers, manufacturers of health-related products, man- agers and administrators throughout the health care system, and public policymakers. The Methods Panel of the Council on Health Care Technology has worked toward the improvement of the methods, techniques, and procedures of technology assessment. The pane] objectives included strengthening of the ability of health care institutions to acquire primary data for the assessment of medical technology, increasing the number of assessments of medical technology that are based upon primary data, strengthening of the methods that provide alter- natives to randomized controlled clinical trials, and development of technology assessment methods, following the development of meth- ods for health quality assessment and assurance. The Methods Panel conducted a variety of projects in pursuit of these goals. Through the council, the Methods Panel promoted the examina- tion of group judgment methodologies by way of a series of work- shops. In June of 1989 the council organized a one-day workshop on International Consensus Development Conferences in conjunc- tion with the annual meeting of the International Society for Tech- nology Assessment in Health Care. The workshop allowed partici- pants to review and consolidate findings on alternative approaches to consensus development efforts, develop recommendations or guide- lines for conducting these efforts, and identify research needs for resolving methodologic questions. This report records the proceed- ings and findings of that workshop. William N. Hubbard, Ir., Chair Jeremiah A. Barondess, Co-chair

OCR for page R1
Contents Introduction . Elements of the Consensus Development Process 1 Sponsorship and Role of Consensus Development Programs within National Health Care Systems................. Itzhak Jacoby Topic and Scope of Consensus Development Conferences: Criteria and Approach for Selection of Topics and Properties for Assessment ................................. Tore Scherste'n Documentation and Use of Evidence in the Consensus Conference Process....................................... Gerard Breart Format and Conduct of Consensus Development Conferences: A Multination Comparison................................. Elizabeth A. McGlynn, Jacqueline Kosecoff, and Robert H. Brook Dissemination and Impact of Consensus Development Statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arnold D. Kaluzny 1X 18 23 32 69

OCR for page R1
x Program Profiles Profile of a Consensus Development Program in Canada: The Canadian Task Force on the Periodic Health Examination . . e e e e ~ e e e e e e e e e e e e e e e e e ~ e e e e e e e e e e Renaldo N. Battista Profile of a Consensus Development Program in Canada: The Canadian Research Group e e e e e e e e e e ~ e e e e e e e Jonathan Lomas Profile of the Consensus Development Program in Denmark: The Danish Medical Research Council and The Danish Hospital Institute . ........................ e e e e e e e CONTENTS 87 93 Torben Jorgensen Profile of the Consensus Development Program in Finland: The Medical Research Council of The Academy of Finland Anna-Liisa Kauppila Profile of the Consensus Development Program in The Netherlands: National Organization for Quality Assurance in Hospitals (CB03 110 Niek S. RIazinga, Anton F. Casparie, and ]. ]. E. van Everdingen Profile of the Consensus Development Program in Norway: The Norwegian Institute for Hospital Research and The National Research Council 118 Born Backe Profile of the Consensus Development Program in Sweden: The Swedish Medical Research Council and The Swedish Planning and Rationalization Institute for the Health and Social Services.......................................... ... 102 125 Stefan Hakansson and Ingemar Eckeriand Profile of the Consensus Development Program in the United Kingdom: The King's Fund Forum 131 Jackie Spiby Profile of the Consensus Development Program in the United States: The National Institutes of Health Office of Medical Applications of Research 137 Sharon R. Baratz

OCR for page R1
CON7INTS Recommendations for Strengthening Consensus Development for Assessing Health Technologies International Consensus Development Bibliography List of Authors X1 147 55 161

OCR for page R1