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B Workshop on Setting Priorities for Practice Guidelines The Institute of Medicine's Committee on Methods for Setting Priorities for Practice Guidelines convened a workshop on Monday, August 15, 1994, in Woods Hole, Massachusetts. The meeting was designed to provide information and ideas for the committee, which met the next day to discuss its recommendations end report. At the request ofthe AHCPR, the agenda included discussion of priority setting in the context of health care restructuring, intergovernmental relationships, and other broad policy issues. Also reflecting discussions with the agency's new leadership, the workshop discussion was not narrowly restricted to priority setting but extended to a much broader range of questions related to the agency's overall responsibilities for guidelines and outcomes research. Jerome H. Grossman, chair of the IOM committee, presided over the meeting. The agenda and list of participants follow. Agenda 8:30 WELCOME, INTRODUCTIONS, AND OVERVIEW Jerome H. Grossman, M.D., Chair, New England Medical Center Marilyn J. Field, Ph.D., Study Director, Institute of Medicine Clifton R. Gaus, Sc.D., Agency for Health Care Policy and Research 9:00 PRIORITIES AND HE:ALTH CARE RESTRUCTURING AND REFORM Sean Tunis, M.D., Office of Health Technology Assessment John T. Kelly, M.D., GMIS Jacqueline B. Kosecoff, Ph.D., Value Health Sciences 93

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94 10:30 Break SEWING PRIORITIES FOR CLINICALPR~CTICE GUIDELINES Greg A. Gifford, Ph.D., Practice Parameter Advisory Committee, State of Minnesota 10:45 PRIORITIES AND RESTRUCTURING: SPECIFIC TOPICS Steven A. Warden, M.D., Ph.D., Mt. Sinai Medical Center, Miami Troyen Brennan, M.D., J.D., Harvard University 12:15 Lunch 1:15 PRIORITY SETTING AND USERS OF GUIDELINES Susan D. Horn, Ph.D., Intermountain Health Care Joseph Selby, M.D., Kaiser Permanente of Northern California William E. Golden, M.D., University of Arkansas George E. Thibault, M.D., Boston-West Roxbury VA Medical Center 2:45 Break 3:00 PRIORITY SETTING AND OTHER GOVERNMENT AGENCIES John H. Ferguson, M.D., National Institutes of Health Thomas V. Holohan, M.D., Office of Health Technology Assessment Discussants: Carolyn DiGuiseppi, M.D., U.S.P.H.S.; Virginia Miller, Ph.D., Department of Labor; Dixie E. Snider, M.D., Center for Disease Control and Prevention RESOURCES, OBJECTIVES, AND PRIORITY SETTING Committee members will raise questions about issues covered earlier in the workshop. 5:15 SUMMING UP Jerome H. Grossman, M.D. Richard Adelson, D.D.S. Director Regional Medical Education Center for Minnesota Minneapolis, MN List of Participants Galen L. Barbour, M.D. Acting Deputy Under Secretary for Health Veterans Administration Washington, DC

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APPENDLY B Robert A. Berenson, M.D. C - Founder and Co-Medical Director National Capital Preferred Provider Organization Bethesda, MD Catherine Borbas, Ph.D. Executive Director Healthcare Education and Research Foundation, Inc. St. Paul, MN Troyen Brennan, M.D. Harvard School of Public Health Department of Health Policy and Management Boston, MA Robert H. Brook, M.D., Sc.D. Professor of Medicine and Health Services UCLA Center for Health Sciences Health Sciences Program Director The RAND Corporation Santa Monica, CA Colonel Edward Burkhalter Director of Clinical Review Group Department of Defense Washington, DC Paul D. Cleary, Ph.D. Associate Professor of Medical Sociology Department of Health Care Policy Harvard Medical School Boston, MA 95 Christine Crofton, Ph.D. Social Science Analyst Agency for Health Care Policy Research Rockville, MD Francis Jay Crosson, M.D. Associate Executive Director The Permanente Group Oakland, CA Norman Daniels, Ph.D. Professor, Department of Philosophy Tufts University Medford, MA Jan DeLaMare C.A.S.E.T. Associates Fairfax City, VA Jane Deng, AMSA Health Policy Fellow University of California, Berkeley Berkeley, CA Carolyn DiGuiseppi, M.D., M.P.H. Principal Staff Member U.S. Preventive Services Task Force Office of Disease Prevention and Health Promotion Washington, DC John H. Ferguson, M.D. Director Office of Medical Applications and Research National Institutes of Health Bethesda, MD

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96 Marilyn J. Field, Ph.D. Senior Staff Officer Institute of Medicine Washington, DC Greg Gifford, Ph.D. Research Analysis Specialist Minnesota Department of Health Health Care Delivery Systems Division Minneapolis, MN William Golden, M.D. Director, Division of General Internal Medicine University of Arkansas Medical Sciences Little Rock, AR Lawrence Gottlieb, M.D., M.P.P. Associate Medical Director Clinical Quality Management Harvard Community Health Plan Brookline, MA Jerome H. Grossman, M.D. Chair and Chief Executive Officer The New England Medical Center Boston, MA David H. Gustafson, Ph.D. Professor of Industrial Engineering and Preventive Medicine Center for Health Systems Research and Analysis University of Wisconsin Madison, WI SETTING PRIORITIES FOR CLINICAL PRACTICE GUIDELINES Michael A.W. Hattwick, M.D. President Woodburn Internal Medicine Associates Annandale, VA Clark C. Havighurst, J.D. William Neal Reynolds Professor of Law Duke University School of Law Durham, NC Neil Hollander Vice President Corporate Health Strategies Blue Cross and Blue Shield of Western Pennsylvania Pittsburgh, PA Susan D. Horn, Ph.D. Senior Scientist Intermountain Health Care Salt Lake City, UT Rosamond Katz Assistant Director Health Finances and Policy Issues General Accounting Office Washington, DC John T. Kelly, M.D. Chief Medical Officer and Senior Vice President for Clinical Information Services GMIS Malvern, PA Jacqueline B. Kosecoff, Ph.D. President and Chief Operating Officer Value Health Sciences, Inc. Santa Monica, CA

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APPENDIX B David Lamer, M.D. Medical Officer Agency for Health Care Policy and Research Rockville, MD Kathleen N. Lohr, Ph.D. Director Division of Health Care Services Institute of Medicine Washington, DC William R. Lohr, Ph.L. Program Director, MCHB Block Grant Maternal and Child Health Bureau Health Resources and Services Administration Rockville, MD Bryan Luce, Ph.D. Director, Center for Public Health Research and Evaluation Batelle Arlington, VA Carole J. Magoffm Executive Director American Medical Review Research Center Washington, DC William L. Medd, M.D. Internist Oxford Hills Internal Medicine Group Norway, ME 97 Christine A. Miaskowski, Ph.D. Associate Professor School of Nursing Department of Physiological Nursing University of California, San Francisco San Franciso, CA Virginia Miller, M.D. Medical Director Office of Workers' Compensation Program U.S. Department of Labor Washington, DC Sandra Robinson Planning Officer Agency for Health Care Policy and Research Rockville, MD William L. Roper, M.D., M.P.H. President The Prudential Center for Health Care Research Atlanta, GA Joseph Selby, M.D. Assistant Director for Health Services Research Kaiser Permanente of Northern California Oakland, CA Cary S. Sennett, M.D., Ph.D. Medical Staff Director Clinical Placating and Improvement Group Health Cooperative of Puget Sound Seattle, WA

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98 SEITING PRIORITIES FOR CLINICS PRACTICE GUIDELINES Richard N. Shiffman, M.D. Assistant Professor of Pediatrics Center for Medical Informatics Yale School of Medicine New Haven, CT Lisa Simpson, M.B., B.Ch. Senior Advisor Agency for Health Care Policy and Research Rockville, MD Dixie E. Snider, Jr., M.D., M.P.H. Acting Associate Director for Science Centers for Disease Control and Prevention Atlanta, GA George E. Thibault, M.D. Chief of Medicine Brockton-West Roxbury Veterans Administration Medical Center W. Roxbury, MA Donna D. Thompson Administrative Assistant Institute of Medicine Washington, DC Sean Tunis, M.D. Senior Health Policy Analyst Office of Technology Assessment U.S. Congress Washington, DC Steven A. Wartman, M.D., Ph.D. Chair Department of Medicine and Professor of Medicine Mt. Sinai Medical Center Miami, FL Linda Johnson White Director Department of Scientific Policy American College of Physicians Philadelphia, PA Art Young Benefits Manager Hewlett-Packard Palo Alto, CA