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OCR for page 565
Inclex
A
Academic institutions, 58
ACC, see American College of Cardiology
ACE, see American College of Physicians
ADAMHA, see Alcohol, Drug Abuse, and Mental
Health Administration
Advocacy, 178-179
Agency for International Development, 38
AHA, see American Hospital Association
Alcohol, Drug Abuse, and Mental Health Adminis-
tration (ADAMHA), 38, 39, 40, 41, 248
Alcohol treatment demonstration project, 519
Alliance for Engineering in Medicine and Biology,
U.S., 232
AMA, see American Medical Association
American College of Cardiology (ACC), 2, 32, 54,
261-274
American College of Physicians (ACP), 2, 33, 38,
54, 55, 62, 63, 129, 195, 213, 275-285, 313
American College of Radiology, 2, 33, 54, 55, 195
American College of Surgeons, 2, 33, 103
American Heart Association (AHA), 261-274
American Hospital Association (AHA), 2, 4, 28, 32,
38, 53, 56, 57, 61, 261-274, 286-293
American Medical Association (AMA), 2, 32, 38,
55, 61, 129, 294-300
Army Medical Research and Development Com-
mand, U.S., 38, 45
Arteriovenous hemofiltration, continuous (CAVH),
299-300
Arthritis Foundation, 222
Aspirin Myocardial Infarction Study (AMIS),186-
187
Assessment
of drugs, see Drug assessment
of medical devices, see Medical device assessment
technology, see Medical technology assessment
B
Battelle Columbus Laboratories, 23
Battelle Memorial Institute, 55, 301-307, 334
BCBS, see Blue Cross and Blue Shield
Beta-carotene trial, 509
Bias, 80
Blue Cross and Blue Shield (BCBS), 2, 33, 38,
53-54, 194-195, 213, 214, 215, 262, 275,
276, 278, 308-327
Blue Cross and Blue Shield Association, 321-323
Boston Collaborative Drug Project, 122
Boston Elbow, 434-435
British Department of Health and Social Services,
20
British National Perinatal Epidemiology Unit
(Oxford), 12
C
CAMM, see Commission d'Autorisation de Mise sur
le Marche
Capital acquisition, 216-217
Cardiac pacemaker implantation, 265-274
Cardiovascular procedures, Task Force on Assess-
ment of, 261-274
Care of the Terminally Ill: Mortality and Eco-
nomics, The, (article), 338-342
Case-control studies, 117, 118
565
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566
Case studies
in medical technology assessment, 97-101
from OTA, 99-100
strengthening, 101
strengths of, 100-101
typology of, 98
weaknesses of, 100
CASS, see Coronary Artery Surgery Study
Catalog systems, online, 412-423
CAVH, see Continuous arteriovenous hemofiltration
CBA, see Cost-benefit analysis
CCPDS, see Centralized Cancer Patient Data Sys-
tem
CDC, see Centers for Disease Control
CDP, see Coronary Drug Project
CDRH, see Center for Devices and Radiological
Health
CEA, see Cost-effectiveness analysis
CEAP, see Clinical Efficacy Assessment Project
Center for Devices and Radiological Health
(CDRH), 49
Centers for Disease Control (CDC), 38, 39, 40, 41,
45, 50, 120, 122, 179
Centralized Cancer Patient Data System (CCPDS),
106, 108
Certificate of Need (CoN) programs, 216-217
Chronic obstructive pulmonary disease (COPD), 133
Cimetidine, 456-468
Civilian Health and Medical Program of the Uni-
formed Services (CHAMPUS), 555
Clearinghouse, international, 12
Cleveland Clinic, 56
Cleveland Metropolitan General Hospital
(METRO), firm trials, 529-533
Clinical Efficacy Assessment Project (CEAP), 129,
213, 275-285
Clinical evaluation, 4, 8-9, 176-207
Clinical situation, 178
Clinical Study Results (summary), 351-354
Clinical trials, 4, 6, 7
basic descriptive material, 495
blinding, 497-498
checklist for comparative, 493-494
comparative, 490-501
compliance, 498
cost-effectiveness model for, 508-509
examples of, 509-510
international, 231-232
national expenditures for, 37-39
NHLBI and, 376
physicians and, 185-187
power, 500
random allocation, 496-497
reporting, 491-500
sample size, 495
selection of patients, 495-496
statistical methods and analysis, 499-500
INDEX
tabulation of outcomes, 499
treatment complications, 499
treatments, 498
withdrawals/loss to follow-up, 498-499
see also Randomized controlled/clinical trials
Cluster approach, 128
CME, see Continuing medical education
Cohort studies, 117-118
College of American Pathologists, 313
Commission d'Authorisation de Mise sur le Marche
(CAMM), 235-236
Commission on Professional Hospital Activities, 182
Communication, channels of, 180-181
Comparative clinical trials, 490-501
Computed tomography (CT), 20-21, 25, 56, 111,
132, 141, 393, 395, 425, 502, 503, 544
Computer knowledge bases, 134-135
CoN (Certificate of Need) programs, 216-217
Consecutive cases, series of, see Series
Consensus activities, international, 232
Consensus Development Conferences (NIH), 131-
133
Consensus Development Program (CDP), 61-62,
129, 13O, 180, 194, 377, 382, 386-404
Continuing medical education (CME), 185-186
Continuous arteriovenous
hemofiltration (CAVH), 299-300
Contraceptive studies, 519
Controlled trial, randomized, see Randomized
controlled/clinical trials
Cooperative Studies Program (CSP), 476-489
Coronary Artery Disease (CAD) data bank (Duke
University Medical Center), 103
Coronary Artery Surgery Study (CASS), 192, 377,
384-385
Coronary bypass surgery, 483-489
Coronary Drug Project (CDP), 187, 190, 193, 196
Cost-benefit, term, 258
Cost-benefit analysis (CBA), 71, 122, 136-144
capabilities and limitations, 141-143
exampleof, 160-164
recommendations for, 144
strengthening uses of, 143-144
usesof,140-141
Cost-Benefit Studies, Smith Kline & French
(SK&F-CBS), 451-468
Cost containment, 9, 10, 214-221
Cost-effectiveness, 58
evaluating, 506-514
model for, 508-509
Cost-effectiveness analysis (CEA),71, 122, 136-144,
508
capabilities and limitations, 141-143
recommendations for, 144
strengtheningusesof, 143-144
usesof, 140-141
Council of Medical Societies (CMS), 277
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INDEX
Council of Medical Specialty Societies, 33, 276
Council of Subspecialty Societies (CSS), 277
CPT, see Current Procedures Terminology
Critical careventilators, 333
Crossover trial, 490-491
Cross-sectional studies, 1 17, 118
CT, see Computed tomography
Current Procedures Terminology (CPT), 114
D
Data acquisition, 71, 247
Data bases, 101-109
capabilities andlimitations of, 106-109
comparison of registers with, 102
strengthening uses of, 109
usesof, 104-106
Data pooling, 87
DATTA, see Diagnostic and Therapeutic Technol-
ogy Assessment Program
Decision-making process, 179
Delphi technique, 130-131, 132
DEN, see Device Evaluation Network
Department of Commerce, 2, 33, 46
Department of Defense (DOD), 38, 40, 45-46, 49,
554,555
Department of Health and Human Services (DHHS).
2,14,33,38,40,42,55,215,216,228,237,
249,250,306,380,437-450,554
Developing countries, medical technology assessment
in, 228-242
Device, see Medical device
Device Evaluation Network (DEN),51
DHHS, see Department of Health and Human Ser-
v~ces
Diagnosis-Belated Groups (DRGs), 10,33,42,57,
88,214-222,224,248,425,438,543,550
Diagnostic and Therapeutic Technology Assessment
Program (DATTA), 294-300
Diagnostic tests and technologies, 80-89
Diagnosticxrays,518
Diethylstilbestrol (DES), 118
Diffusion of technology, 8, 177-185
as affected by evaluation, 182-185
determinants of, 178-181
empiricalpatternsof, 184
evidence about effects of evaluation on, 185-195
idealized pattern of, 183
measures of, 181-182
Dimethyl sulfoxide (DMSO), 226
Do-not-admit surgery study, 519
DOD, see Department of Defense
DRG, see Diagnosis-Related Group
DRMS, see Drug Reaction Monitoring System
Drug(s)
assessment, 47-49
in different countries, l l-12,234-237
expenditures for, 48-49
567
industry, 46-49
expenditures, 3-4
R&D, 46-47
postmarketing surveillance of, 240-241
term, 256
treatment for hypertension, 21-22, 25
Drug Price Competition and Patient Restoration Act
of 1984,49
Drug Reaction Monitoring System (DRMS), 105
Dyspepsia, endoscopy in, 282-285
E
ECRI,2, 4, 5, 33, 34, 38, 53, 57, 61, 62, 63,
328-333
Effect sizes, 125
Effectiveness, term, 71, 258
Efficacy, term, 71, 258
EFM, see Electronic fetal monitoring
EIES, see Electronic information exchange system
E1 Camino Hospital, 23-24
Electro Spinal Orthosis (ESO), 351-354
Electronic fetal monitoring (EFM), 19-20, 25
Electronic information exchange system (EIES), 135
Eleventh Congress of European Dialysis and Trans-
plant Association, 234
Emergency Care Research Institute, see ECRI
Employer contributions for hearth, 59
End-stage renal disease (ESRD), 155-156, 234,
344-346, 518-519
Endoscopy in dyspepsia, 282-285
Environmental constraints and incentives, 179
Environmental Protection Agency (EPA), 306
Epidemiologic methods, 116-120
capabilities and limitations of, 119
strenghening uses of, 119-120
uses of, 117-118
ESO, see Electro Spinal Orthosis
ESRD, see End-stage renal disease
Ethical issues, 154-159
experience in addressing, 157-158
term, 258
Ethics of investigation, 158-159
European Economic Community, 234, 235
European Free Trade Association, 234
Evaluation, 176-177
diagnostic technologies and, 80-89
diffusion as affected by, 182-185
evidence about effects of, on diffusion, 185-195
of medical and social experiments, 506-513
medical practices and, 193-194
methods of, 80-89, 179-180
physicians and, 185-195
primary, physicians and, 185
regulation and, 195-196
studies, 198-207
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568
synthetic, 194-195
types of, 176
Expenditures, national, 37-39
F
FDA, see Food and Drug Administration
Federal government, 39-46
expenditures, 3
payers for health care, 28-29, 554-564
Federalism, new, in technology assessment, 542-553
Federation of County Councils, 12, 229
Fetal monitoring, electronic (EFM), 19-20
Food, Drug, and Cosmetic Act, 4, 49, 52, 60, 234,
545
Food and Drug Administration (E;DA), 4, 11, 13, 18,
27, 38-41, 47-52, 56, 59-62, 105, 121-122,
177, 179, 195-196, 213, 224-225, 229, 237,
244, 306, 321, 349-350, 359-360, 454, 481,
507, 545, 561-562
Freedom of Information Act, 108
G
General Accounting Office, U.S., 2, 42, 312, 428
Georgetown University, 334
Government, federal, see Federal government
Grab samples, 96
Group Health Association of America, 56
Group Health of Puget Sound (GHC), 56, 57, 521-
524
Group judgment methods, 129-136
designed for health issues, 131-135
formal, 130-131
strengthening, 135-136
Group practice, prepaid, 515-524
randomized controlled trial with, 525-528
H
Hartford Foundation, 278
Harvard Community Health Plan, 56, 57, 520-521
Hastings Center, 38, 55, 63, 334-342
Hawthorne effect, 532-533
HCA, see Hospital Corporation of America
HCFA, see Health Care Financing Administration
HCT, see Historically controlled trial
HDP, see Health Devices Program
Health and Population Study Center (Battelle
Memorial Institute), 302, 305
Health and Public Policy Committee (ACP), 277-
278
Health care
government payers for, 554-564
of the terminally ill, 338-342
values and preferences in delivery of, 535-541
Health Care Financing Administration (HCFA),
5-7, 10, 38-43, 58-6O, 63-64, 72-73, 112-
114, 179-180, 196, 212-214, 218, 222-223,
INDEX
250-251, 287-288, 302-308, 321, 355-363,
377, 554, 556-557, 560-563
Health care systems in different countries, 237-239
Health Devices Program (HDP), 328-333
Health information, international, 239
Health Insurance Plan of Greater New York (HIP),
147
Health Interview Survey, 182
Health maintenance organizations (HMOs), 27-28,
38, 56, 57, S9, 119, 453, 470, 515
Health Policy Research Group (Hastings Center),
335
Health Program (OTA), 424-436
Health Promotion and Disease Prevention Amend-
ments of 1984, 44
Health registers, see Registers
Health Resources and Services Administration
(HRSA), 38, 40
Health Services Research, Division of, 343-346
Hemofiltration, continuous arteriovenous (CAVH)
299-300
Hepatitis Knowledge Base, 135, 409, 410
High blood pressure, see Hypertension
Historical control groups, 491
Historically controlled trial (HCT), 75-76
HMOs, see Health maintenance organizations
Hospital computer system, S19
Hospital Corporation of America (HCA), 57-58
Hospital Discharge Survey, 182
Hospital stay for myocardial infarction, 191-192
Hospital Technology Series Program, 286-293
HRSA, see Health Resources and Services Adminis-
tration
Human Affairs Research Centers (Battelle Memorial
Institute) (HARC), 301-307
Hypertension, drug treatment for, 21-22, 25
Hypertension Detection and Follow-up Program
(HDFP), 186, 188, 194
Hysterectomy, 22-23, 25
~,
I
ICD, see International Classification of Diseases
IDE, see Investigational device exemption
IHCE, see Institute of Health Care Evaluation
IMPS, see Institute for Health Policy Studies
IND, see Investigational new drug
Industry associations, 55-56
Information
combining, 125, 247
dissemination of, 247
monitoring and acquisition, 246-247
needs for technology assessment, 502-505
system, medical, 23-24
Innovations, 178
Institute for Health Policy Studies (IHPS), 469-475
Institute of Health Care Evaluation (IHCE), 222-
223
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INDEX
Institute of Medicine (IOM), 1, 12, 33, 154, 157,
223, 242
Institute of Society, Ethics and the Life Sciences,
334-342
Insurance, private, 10
Insurers, 53-54
Intensive care units, 432-434
International Classification of Diseases (ICD),
114-115
International clearinghouse, 12
International health information, 239
International organizations, 239-241
International pharmaceutical firms, 239
Investigational
device exemption (IDE), 51
new drug (IND), 47
IOM, see Institute of Medicine
J
Joint American College of Cardiology/American
Heart Association Task Force on Assessment
of Cardiovascular Procedures, 261-274
Joint Commission on Prescription Drug Use, 124
Joint National Committee on Detection, Evaluation,
and Treatment of High Blood Pressure, 186
K
Kaiser-Permanente Medical Care Program
(KPMCP), 56-57, 96, 105, 343-346, 517-520
Kennedy Institute of Ethics, 334
L
Legal considerations, 224-226
Lister Hill National Center for Biomedical Com-
munications (NML), 406-408
Liver transplantation, 397-404
M
Mammary artery ligation, internal, 17-18
Manpower for technology assessment, 248
Massachusetts Hospital Association (MHA), 54
Mathematical modeling, 144-154
background of, 145
example of, 146, 164-166
limitations of, 150-152
role of, 146-147
strengthening, 152-153
types of, 148-149
uses of, 147-148
validation of, 149-150
Matching, 491
Mayo Clinic, 56, 96
MDR, see Medical device reporting
Medicaid, 43, 113, 214, 215, 221, 543, 544, 550,
554-564
Medical and social experiment, evaluation of cost-
effectiveness of, 506-513
569
Medical associations, 54-55. See also specific assoc'-
ations.
Medical Care Group of Washington University
(MCG), 525-528
Medical Device Amendments of 1976, 4, 50-51, 52,
60
Medical devices
assessment, 4, 50-53
expenditures for, 4, 52-53
industry, 49-53
reporting (MDR), 51
term, 256-257
Medical information system, 23-24
Medical Literature Analysis and Retrieval System
(MEDLARS), 239, 406, 410
Medical Methods Research (MMR), Division of,
343-346, 517-518
Medical Necessity Program, 195, 213, 262, 275, 276,
278, 309-318
Medical Practice Information Project, 133-134
Medical practices, evaluation and, 193-194
Medical procedure, term, 257
Medical technology
application of, 258-259
assessment, 1-2
abroad, 11-12
alternative, 503
case studies in, 97-101
comprehensive, 25-26
comprehensiveness of U.S., 36
conclusions and recommendations, 13-15,
244-254
coordination of, 61
costs of, 502-503
definition of type of, 502
in developed countries, 228-242
different aims in, 26-30
dollar level of effort in, 3
effects of clinical evaluation on diffusion of
technology, 8-9, 176-210
in era of retrospective payments, 212-214
examples of, 19-25
financial support for, 6, 62-64, 252-253
functional specifications for, 502
information needs for, 246-247, 502-505
institutional arangements for, 249-251
introduction, 16-31
key functions for, 13-14, 246-249
lags in, 5
manpower for, 248
mathematical modeling and, 144-154
methods of, 6-8, 70-166, 259
need for, 214-221
in new era of cost containment, 10, 214-221
new federalism and state support for, 542-553
paying for, 10-11, 221-223
in prepaid group practice, 515-524
OCR for page 570
570
primary purpose of, 9
principal technologies in programs, 35-36
program profiles, 255-489
recommendations on, 6, 11, 61-64, 252-253
reimbursement and, 9-11, 211-226
research and development for, 37-39, 230-232,
248-249
responsibility for conduct of, 61-62
scope of U.S., 2-6, 32-69
selected attributes of, 34
social and ethical issues in, 154-159
summary, 1-15
systematic approach to, 18-19
technical specifications of, 502
trends in, in developed countries, 229-230
types of, 8-9
varieties and expense of, 3-5
varieties of, 34-36
in different countries, 232-234
stage of, 258
Medicare, 7, 10, 29, 32-33, 43, 56, 57, 63, 113-114,
196, 211, 212, 214-216, 220-221, 224, 251,
305, 321, 356, 363, 437, 438, 543, 544, 554-
564
Medicare prospective payment system (PPS), 437-
450
Medicare Statistical System, 113-114
MEDLARS, see Medical Literature Analysis and
Retrieval System
Medtronic, Inc., 347-354
Mental models, 146
Meta-analysis, 125-129
Metro Firm trials, 529-534
Mild hypertension trial, 509-510
Modeling, simulation by, 7
Morbidity and Mortality Weekly Report (MMWR),
120
Multiphasic health testing, 519
Myocardial infarction, hospital stay for, 191-192
N
National Ambulatory Medical Care Survey
(NAMCS), 110, 111
National Cancer Institute (NCI), 40, 104, 373, 382
National Burn Demonstration Project, 395
National Center for Health Care Technology
(NCHCT), 14, 64, 110, 196, 212, 249, 250,
306, 543
National Center for Health Services Research and
Health Care Technology Assessment
(NCHSRHCTA), 33, 38, 39, 40, 43-44, 59,
62, 105, 212, 248, 250, 252, 253, 355-363,
387, 517
National Center for Health Statistics (NCHS), 40, 182
sample surveys, 110-114
statistics, 44-45
INDEX
National Commission for the Protection of Human
Subjects (NCPHS), 157-158
National Committee on Vital and Health Statistics,
115
National Disease and Therapeutic Index, 182
National expenditures, 37-39
National Eye Institute (NEI), 361
National Health Interview Survey (NHIS), 110
National Health Service (NHS), 237-238
National Health Survey Act of 1956, 110
National Heart, Lung, and Blood Institute
(NHLBI), 59, 60, 61, 64, 103, 186, 187, 262,
306, 373-385
National Heart Transplantation Study, 302, 304,
305, 306
National Hospital Discharge Survey (NHDS), 110-
111, 115
National Implant Registry, 104
National Institute for Handicapped Research
(NIHR), 50
National Institutes of Health (NIH), 2, 3, 5, 18, 32,
38-44, 50, 58-62, 129-133, 180, 194, 222,
232, 252, 373, 382, 386-404, 506-507. see
also Consensus Development Conferences;
and specific institutes
National Kidney Dialysis and Kidney Transplanta-
tion Study, 303, 304
National Library of Medicine (NLM), 134, 239, 331,
405-423
National Medical Care Utilization and Expenditure
Survey (NMCUES), 112-113
National Mortality Survey, 112
National Multiple Sclerosis Society, 222
National Natality Survey, 112, 114
National Science Foundation (NSF), 37
National Society of Hospital Pharmacists, 111
National Survey of Family Growth, 122
Navy Medical Research and Development Com-
mand, U.S., 45
NCHCT, see National Center for Health Care Tech-
nology
NCHS, see National Center for Health Statistics
NCHSRHCTA, see National Center for Health Ser-
vices Research and Health Care Technology
Assessment
NCI, see National Cancer Institute
Negative trials, 492-493
New drug application (NDA), 47
NOT see Nominal group technique
NHDS, see National Hospital Discharge Survey
NHLBI, see National Heart, Lung, and Blood
Institute
NHS, see National Health Service
NIH, see National Institutes of Health
NIHR, see National Institute for Handicapped
Research
NLM, see National Library of Medicine
OCR for page 571
INDEX
NMCUES, see National Medical Care Utilization
and Expenditure Survey
NMR, see Nuclear magnetic resonance
Nominal group technique (NOT), 131
Northern California, technology assessment in,
517-519
Northern California Kaiser Foundation Health Plan
(KFHP), 345-346
NSF, see National Science Foundation
Nuclear magnetic resonance (NMR), 21, 289-293,
431-432
o
GASH, see Office of the Assistant Secretary for
Health
OASPE, see Office of the Assistant Secretary for
Planning and Evaluation
Observational studies, 491
Occupational Safety and Health Administration
(OSHA), 41, 306
Office of Health Research Statistics and Technology,
95
Office of Health Technology Assessment (OHTA),
5,7,38,39,40,41,44,59,72,73,212,244,
287, 355-363, 377, 387
Office of Medical Applications of Research (OMAR),
41, 132, 232, 377-380, 386-404
Office of Research and Demonstrations (ORD), 43
Office of Technology Assessment (OTA), 1-2, 5, 14,
25-26, 33, 38-42, 59, 72, 99-100, 110, 115,
136-143, 155-156, 160, 193, 196, 215, 217,
223, 244, 249-250, 256, 334, 424-436, 442,
472-473, 515, 544
Office of the Assistant Secretary for Health, 40, 355,
356
Office of the Assistant Secretary for Planning and
Evaluation (OASPE), 43
OHTA, see Office of Health Technology Assessment
OMAR, see Office of Medical Applications of
Research
Online catalog systems, 412-423
ORD, see Office of Research and Demonstrations
Oregon, technology assessment in, 519-520
Organization of Economic Cooperation and Devel-
opment, 12, 230
Organizational/administrative system, term, 257
Organizations, selected, 35-36
Orphan Drug Act of 1983, 49
OSHA, see Occupational Safety and Health Admin-
istration
OTA, see Office of Technology Assessment
p
p-values, 127
Pacemaker implantation, cardiac, 265-274
Pap smear, 164-166
571
Paralytic poliomyelitis, 17
Patient information, 503-504
Peer Review Organizations (PROs), 221
Peptic ulcer disease, 456-468
Percutaneous transluminal angioplasty (PTA), 364-
372
Permanente Medical Group, The (TPMG), 343-346
Pharmaceutical firms, international, 235, 239
Pharmaceutical Manufacturers Association (PMA),
3-4, 37-38, 46, 47, 56, 61
Phase IV studies, 48
Physicians
clinical trials and, 185-187
evaluation and, 185-195
primary evaluation impact on, 185
RCTs and, 187-193
PMA, see Pharmaceutical Manufacturers Association
PMAA, see Premarket approval application
Policy research groups, 55
Poliomyelitis, paralytic, 17
Population information, 503-504
Postmarketing studies, 4, 48
Postmarketing surveillance of drugs, 240-241
Potential adopter, 179
Practice setting, 179
Predictive value positive and predictive value nega-
tive, 82-83
Premarket approval application (PMAA),4,51,52
Premarketing studies' 4, 47-48
Prepaid group practice, 515-524, 525-528
President's Commission for the Study of Ethical
Problems in Medicine and Biomedical and
Behavioral Research, 157-158
Prevailing theory, 178
Prevalence of disease, 83
Priority setting, 247-248
Private insurance, 10, 224-226
Private-public body, 249-250
Private sector assessment activities, 4-5, 53-59
Product Reporting Program (PRP), 51
Profile narratives, 256
Program profiles, 255-489
Prospective Payment Assessment Commission
(ProPAC), 33, 40, 42, 62, 63, 218, 220, 223,
425, 437-450, 543
Protocol, 74-75, 79, 92-93
Provider information, 503-504
Provider institutions, 56-58
PRP, see Product Reporting Program
PTA, see Percutaneous transluminal angioplasty
Public Health Service (PHS), 61, 62, 63, 195, 196,
212, 306, 355, 356, 361
Public Health Services Act, 28
Q
Quantitative synthesis methods, 125-129
OCR for page 572
572
R
R&D, see Research and development
Rand Corporation, 55, 130, 132, 395
Rand-UCLA Health Serviees Utilization, 134
Randomized eontrolled/clinical trials (RCTs), 6, 8,
21, 121, 123, 128-129, 145, 147, 177, 178,
196, 507
electronic monitoring and, 19-20
innovative approach to ongoing, 529-534
lack of, 93-94
limitation of, 76-78
physicians and, 185-193
prepaid group practice and, 525-528
protocol of, 74-75, 79
strengthening use of, 78-79
treatments and, 74, 75-76
uses of, 490-491
Receiver operating characteristic (ROC) curve, 83-
88
Reference standard, 86-87
Registers, 101-109
approximate costs of, 108
capabilities and limitations of, 106-109
comparison of data bases with, 102
strengthening uses of, 109
uses of, 104-106
Regulation, evaluation and, 195-196
Regulatory authority, 251-252
Reimbursement, technology assessment and, 211-226
Renal disease, end-stage (ESRD), 155-156
Replicability, term, 80
Research, identification of gaps in knowledge that
require, 247
Research and development (R&D), 3, 4, 5, 58, 59-
60
in developed countries, 230-232
for drug industry, 4, 46-47
for health, 37-53
for medical device industry, 49-50
of methods for assessment, 248-249
ROC, see Receiver operating characteristic
S
Safety, term, 258
Sample surveys, 109-116
capabilities and limitations of, 114-115
NCHS, 110-113
strengthening uses of, 115-116
uses of, 110
SEER, see Survival, Epidemiology, and End-
Results) Program
Sensitivity, term, 82
Sensory evoked potential (SEP), 324-327
Series
capabilities and limitations of, 91-92
clear-cut, 94-95
INDEX
of consecutive eases, 90, 92-94
description of, 90
grab samples and, 96
integrity of counting, 92
interfering variables and, 90-91
interpretation of, 90, 92-94
leek of randomization and, 93-94
protocol and, 92-93
subgroups and, 95
temporal drift and, 96
Serum alpha-fetoprotein, 518
Significance levels, 125
cumulation of, 127
Smith Kline & French Cost-Benefit Studies
(SK&F-CBS), 451-468
Soeial issues, 154-159
Soeial Seeurity Aet, 212
Soeial Seeurity Aet Amendments, 212, 221, 250
Soeial Seeurity Administration, 355
Soeial Seeurity Reform Aet of 1983, 10, 42, 215
Southern California, technology assessment in, 520
Specificity, term, 82
Speech impairments, 430-431
SPRI, see Swedish Planning and Rationalization
Institute of Health Serviees
Standard error (SE) for the mean, 95
Standard minimum data set, recommendation for,
505
State-of-the-art diagnosis, 133
State support for technology assessment, 542-553
Stevenson-Wydler Technology Innovation Aet, 2, 33
Stratified trial, 491
Summaries of studies, 198-207
Support system, term, 257
Surgical procedure, 17, 25, 257
Surveillance, 120-124
capabilities and limitations of, 123-124
of drugs, 240-241
strengthening uses of, 124
uses of, 121-123
Surveys, see Sample surveys
Survival, Epidemiology, and End-Results (SEER)
Program, 104, 107
Swedish Medieal Research Council, 232
Swedish Planning and Rationalization Institute of
Health Serviees (SPRI), 11-12, 229-230
Synthesis
example of, 128-129
methods, quantitative, 125-129
T
Tax Equity and Fiscal Responsibility Act (TEFRA),
215, 217
Team primary care, 519
Teehnieon Medieal Information System (TMIS),
23-24
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INDEX
Technology assessment, medical, see Medical tech-
nology assessment
Technology diffusion, see Diffusion of technology
Technology Evaluation and Coverage Program
(TEC), 312, 319-327
Technology transfer, international, 232
Television, and community health, 519-520
Temporal drift, 96
TMIS, see Technicon Medical Information System
U
Uniform Hospital Discharge Systems (UHDDS), 221
Uniform Medical Policy, 321-327
University Group Diabetes Program (UGDP), 159,
187-188, 189-190
573
V
VA, see Veterans Administration
Ventilators, critical care, 333
Veterans Administration (VA), 2, 21, 33, 38, 39, 45,
50, 51, 57, 96, 425, 47~489, 555-556
Voting methods, 126-127
W
Wheelchairs, 435-436
World Health Organization (WHO), 11, 12, 121,
122, 124, 193, 196, 229, 234, 235, 236, 240-
241, 242
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Representative terms from entire chapter:
medical device
