National Priorities for the Assessment of Clinical Conditions and Medical Technologies Report of a Pilot Study (1990) / Chapter Skim
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2 A Pilot Process for Setting National Assessment Priorities
2 A Pilot Process for Setting National Assessment Priorities
Pages 15-26
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From page 15... ...
Recognizing these methodologic difficulties, the council undertook this pilot effort to set a framework for national pnontysetting, outline national pnonty-setting cntena, and use a consensus process to identify a first-cut list of priority areas for the assessment of clinical conditions and medical technologies. An expanded effort proposed by the council would build on what was reamed from the pilot work, available data, and funkier methodolog~c development.
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From page 16... ...
NATIONALLY APPLICABLE PRIORITY-SETTING CRITERIA The following pnon~-se~ng criteria identified by the Council on Health Care Technology are based upon important factors commonly recognized by the multiple heath sectors represented In me council, including academia' government, health care provided, health care manufacture~, and payers. The criteria were used to choose He 20 assessment areas identified in this pilot report and to facilitate He comparison of the pnonty-serdng criteria used by some of Be organizations providing informadon for this pilot study (see Appendix By.
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From page 17... ...
The perception of what constitutes an improved patient outcome may be different for patients, providers, payers, health care product makers, or policymakers. Potential to Affect a Large Patient Population The potential impact of an assessment may be enhanced if the prevalence of Me clinical condition or the frequency of use of the technology is high.
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From page 18... ...
Potential to Reduce Unexplained Variat~ons in Medical Practice Unexplained variations refer to differences in the use of technologies for a clinical condition, or the associated patient outcomes, Hat cannot be explained by differences in identifiable patient characteristics such as disease seventy or sociodemographic factors. The results of an assessment may lead to changes in medical practice that would reduce unexpla~ned variations in the use of drugs, devices, or procedures.
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From page 19... ...
The potential benefit of emerging ~rugs' devices, or procedures that are not yet being used for a large number of patients may be enhanced as a result of an assessment Potent~al to Affect Policy Decisions Well-conducted assessments of the medical practices in question might elucidate policy options for me avocation of national resources, He formulabon of regulatory and reimbursement policies, and me management of health benefit programs. Evaluations of Be relative effectiveness of altemative technologies may provide Me scientific justification for practice guidelines for specific coca conditions or technologies.
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From page 20... ...
While the council favors the clinical condition approach to evaluating medical practice, it recognizes that a single approach should not dominate and that a national process for setting pnonties must accommodate the needs of those oriented to different approaches. The conceptual framework for priorities accommodating clinical conditions and technologies was developed after reviewing the approaches used by a selection of different types of health care organizations (see Appendix C)
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From page 21... ...
2 Patient outcomes are defined as "the range of results Mat proceed from (or are presumed to be associated with) the provision of health care services." Lee concept of patient outcomes includes physiologic, functional, emotional mental, and social dimensions of health (Lohr, 1988~.
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From page 22... ...
The technology approach to identify priorities was used by some of the groups involved in the payment or purchasing of health care services that provided background information for this project (see Appendix C)
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From page 23... ...
For high-pr~or~ty clinical conditions, the adtemative technologies Hat may be used for prevention, screening, diagnosis, and treannent were considered. For high-pnonty, cross cueing technologies the range of alternative preventive, screening, diagnostic, or annent indications was taken into account These interrelated am preaches can be used to represent the concerns of those oriented to a technology approach, as well as the concerns of those oriented to a clinical condition approach.
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From page 24... ...
Round ~ of the Modified Delphi Process The goal of Round ~ was to develop a broad list of potential assessment topics. Staff compiled this composite list after consulting individuals andJ or publications from the 14 organ~zabons descnbed in Appendix C
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From page 25... ...
After several rounds of elim~nadon based on voting and mnking exercises, Me group concluded that the lack of readily accessible unfond data to justify rankings of all the candidates by each of the criteria meant that a methodologically sound quantitative tanking would not be possible for this pilot effort. Throughout its deliberations, the priority-setting group, however, felt that it was important to limit the final list to a manageable number of assessment areas.
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From page 26... ...
The draft report was reviewed and approved by the prionty-setting group, the Council on Heath Care Technology, and external peer reviewers according to the standard procedures of the National Academy of Sciences.
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