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SCARY The Institute of Medicine established the Committee to Plan a Private/Public Sector Entity to Assess Technology in Medical Care in December 1982, and charged it with the development of a plan for a technology assessment organization that would be based in the private sector but supported by both government and non-governmental parties. This initiative grew out of an exploratory meeting convened by the Institute on June 16, 1982, in response to growing concerns in both public and private sectors about the proliferation of technologies in medical care. The concerns have several aspects: pressures to elimi- nate technologies that may be obsolete, harmful, or ineffective; desires to affirm the benefits of other technologies; and stringencies of the need to slow the growth of costs while maintaining and improving the quality of American medical care. The committee completed its work on June 30, 1983, recommending the creation of a Medical Technology Assessment Consortium as a part of the Institute of Medicine. Based in the private sector, the consortium is to seek support that would be approximately evenly divided between governmental and non-governmental resources. The functional priorities of the consortium call for it, first, to establish and maintain an information clearinghouse in medical technology assessment. Tnis clearinghouse function would build a communications network among the principal parties to technology assessment--other technology assessment entities, manufacturers of drugs and devices, the professional users of technologies, third party payers, and the major health care providers. The clearinghouse function would serve to reduce unneeded or unrecog- nized redundancies in evaluation, establish a central repository of information on completed and ongoing assessments, provide a forum for all the parties at interest in the development and validation of tech- nologies, and facilitate the dissemination of information on medical technology assessments. The consortium is not intended as a competitor or as ~ replacement for any existing entity involved in assessing med- ical technologies. Rather ~ it is to be complementary and facilitative of the efforts of others involved in responsible assessments of medical technologies. Second, the consortium should develop a capability to synthesize g evaluate, and interpret the reports and data generated by others involved in medical technology assessment. This is an activity of "secondary" assessment, which adds to the information retrieval and dissemination tasks of the clearinghouse function. ~ . X11
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Third, the consortium should be prepared to stimulate, coordinate, conduct, or commission original assessments of medical technologies. This function is generally teemed "primary" assessment--the generation of new facts upon which to base direct judgments. Recognizing this as a major research need in the field, the committee chose the broadest possible role for the consortium in original research. Fourth, the consortium should function in the identification of needs for technology assessment, conducting consensus-building activities on the specific question of which technologies are in need of evaluation or re-evaluation. Along with this, in the committee's view, is a responsibility of the consortium to help identify areas in which more technologic development would be desirable. Fifth, the consortium should contribute to the development and evaluation of criteria and methods for assessment of technologies in medical care. The committee does not provide a definitive review and evaluation of assessment methods in this report, but it wishes the consortium to be capable of such examination so as to improve the quality of research in assessment. Sixth, and last, the consortium should become involved in education and training, and provide technical assistance to others interested or engaged in medical technology assessment. This function attempts to round out the desired range of services that might be offered through the consortium by allowing it to complement primary and continuing education efforts of others, and to serve as a resource for improving the technology of technological evaluation. The consortium should seek at least $300,000 for its first year of operation, and should have an annual budget of at least $1 million in its third year. The clearinghouse function should be initiated in the first year and be fully operational by the third O A $1 million budget should be sufficient to support the clearinghouse activities, but as the consortium activates its other intended functions, particularly those of conducting or commissioning primary data-based research, the annual budget must increase substantially. Several funding possibili- ties are proposed, including congressional appropriations, fee-for- service work, or combinations of those. . . . X111
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