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Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest (1991)

Chapter: Appendix A Agenda and Summary of IOM Invitational Workshop

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Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
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Appendix A
Institute of Medicine Workshop on Conflicts of Interest in Patient Outcomes Research Teams

PROGRAM AND SUMMARY

On June 11 and 12, 1990, the Institute of Medicine (IOM) sponsored a workshop on Conflicts of Interest in Patient Outcomes Research Teams (PORTs). The workshop was planned by a steering committee formally appointed to the task by the IOM. The purpose of the IOM workshop was to assist the Agency for Health Care Policy and Research (AHCPR), PORTs, and other parties to anticipate conflicts of interest and to identify issues to consider in dealing with them to ensure the credibility of PORT assessments.

Invitations to attend the conference were sent to the principal investigators of all currently funded PORTs and planning grantees and to others who represented the perspectives of academic institutions, industry, health services research, law, third party payers, policymakers, AHCPR, and congressional staff. About 60 participants and IOM staff attended the one-and-a-half day meeting. Background materials, such as recent policy statements on conflicts of interest in academic centers and papers commissioned for the workshop, were distributed to participants before or at the time of the conference.

The first day of the workshop included introductory remarks by Samuel O. Thier, president of the IOM, and a presentation by John Wennberg, principal investigator of the Dartmouth PORT. J. Jarrett Clinton, acting administrator of AHCPR, provided an update on and his views of the Medical Treatment Effectiveness Program.

The remainder of the first day included panel and participant discussions of three scenarios written for the workshop. Topics raised in the scenarios ranged from relatively straightforward equity and consulting

Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×

issues to more elaborate situations involving possible academic and professional conflicts of interest and joint ventures involving industry, payers, academic institutions, PORTs and AHCPR. The discussions were led by the chairman of the committee, Alexander Capron. After each scenario a rapporteur summarized the discussion (Appendix C).

On the second day, Christine Williams, a member of the staff of Senator George Mitchell, spoke about ''Congressional Views and Expectations for the PORTs." Judith Lave, a health economist, discussed PORTs' impact on health services research, technology innovation, and payment policy. The conference concluded with a discussion among a panel composed of the committee chairman, the rapporteurs of the three scenarios, and all workshop participants.

The workshop discussions illuminated the difficulty of forming specific rules for dealing with problematic and complex cases. Such decisions tend to be made more on the basis of what is perceived to be common practice than on consideration of whether such common practice constitutes a reasonable and defensible action. Participants expressed a wide spectrum of views about the inherent danger of any given activity. Understanding how such ad hoc rules would affect researchers, research, funding and, more distantly, the public welfare, are beyond our current capacity. Such complex cases will, however, form the "case law" for managing conflicts of interest.

As an exercise for the committee, the discussions helped to make concrete the risks and benefits of various financial and professional relationships intrinsic to the PORT methodology. They broadened the views of the committee to include the experiences and expectations of current PORT investigators and others.

Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×

Agenda

Day 1: Monday, June 11, 1990 (Salons D&E)

8:00 a.m.

Registration and Continental Breakfast

8:40 a.m.

Welcome and Opening Remarks

 

Samuel Thier, President

 

Institute of Medicine

9:00 a.m.

PORT Structures and Methods

 

John Wennberg, Dartmouth Medical School

9:30 a.m.

Discussion

9:45 a.m.

Scenario I: Presentation and Panel Discussion

 

Moderator: Alexander Capron

 

Panel: Bernard Barber, Bruce Brennan, Barbara Hansen, Barbara Mishkin, Earl Steinberg

 

Rapporteur: David Blumenthal

10:30 a.m.

BREAK

10:45 a.m.

Continue Panel Discussion and Participants' Views

11:45 a.m.

Rapporteur Summary

12:00 p.m.

LUNCH (SALON H)

1:00 p.m.

Luncheon Speaker: Update on Activities of the Medical Treatment Effectiveness Program

 

J. Jarrett Clinton, Acting Administrator

 

Agency for Health Care Policy and Research

1:30 p.m.

Scenario II: Presentation and Panel Discussion

 

Moderator: Alexander Capron

 

Panel: Marilyn Bergner, John Brown, Peter Budetti, C. K. Gunsalus, David Pryor

 

Rapporteur: Marcia Angell

Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×

2:15 p.m.

Participants' Views and Discussion

2:45 p.m.

Rapporteur Summary

3:00 p.m.

BREAK

3:15 p.m.

Scenario III: Presentation and Panel Discussion

 

Moderator: Alexander Capron

 

Panel: Peter Barton Hutt, David Korn, Bryan Luce, Barbara McNeil, Lawrence Morris

 

Rapporteur: Michael Pollard

4:00 p.m.

Participants' Views and Discussion

4:30 p.m.

Rapporteur Summary

4:45 p.m.

What Emergent Issues Have Not Been Revealed by the Scenarios?

 

Discussion

5:30 p.m.

BREAK

6:00 p.m.

RECEPTION (SOUTH GALLERY)

6:30 p.m.

DINNER (SALON H)

Day 2: Tuesday, June 12, 1990 (SALON II)

8:30 a.m.

Continental Breakfast

9:00 a.m.

Congressional Views and Expectations of Outcomes

 

Research by PORTs

 

Christine Williams, Legislative Assistant

 

Office of Senator George J. Mitchell

9:30 a.m.

Envisioning the Role and Significance of PORTs for Health Services Research, Technology Innovation, and Payment Policy

 

Judith Lave

Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×

10:00 a.m.

BREAK

10:30 a.m.

Anticipating and Managing Conflicts of Interest: Points to Consider for AHCPR, PORTs, Industry, and Others

 

Roundtable Discussion and Participants' Views

 

Alexander Capron (Moderator), Marcia Angell, David Blumenthal, Michael Pollard

11:30 a.m.

Summary of Discussion

Noon

Adjourn Workshop

12:15 p.m.

Executive Luncheon Session of Steering Committee

 

(SALON C)

Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×
Page 99
Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×
Page 100
Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×
Page 101
Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×
Page 102
Suggested Citation:"Appendix A Agenda and Summary of IOM Invitational Workshop." Institute of Medicine. 1991. Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest. Washington, DC: The National Academies Press. doi: 10.17226/1821.
×
Page 103
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The new Agency for Health Care Policy and Research in the U.S. Public Health Service is funding a set of multidisciplinary groups called Patient Outcomes Research Teams (PORTs). Their purpose is to assess alternative treatments for medical conditions using a variety of outcome measures. In guiding insurance coverage, these PORTs are expected to wield considerable influence on medical practice and health policy.

This book addresses possible threats to their credibility that might be based on real or apparent conflicts of interest, including both financial and other conflicts. It raises points to consider for the new agency, for PORTs and their institutions, for industry, for the health services research community, and for the U.S. Congress in avoiding and managing conflicts of interest.

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