Setting Priorities for Health Technologies Assessment A Model Process (1992) / Chapter Skim
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1 TECHNOLOGY ASSESSMENT AND THE NEED FOR PRIORITY SETTING
1 TECHNOLOGY ASSESSMENT AND THE NEED FOR PRIORITY SETTING
Pages 17-30
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From page 17... ...
. Its broader objective, however, is to propose a process that has wider applications and general utility to other organizations that must set priorities for health technology assessment.
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Two separate, but related, areas of research-variations research conducted by John Wennberg and others and appropriateness research conducted by Robert Brook and his colleagues have led policymakers and health services researchers to argue Hat efforts to control costs should fo
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From page 19... ...
Such efforts toward more rigorous evaluation of medical practice are variously called outcomes and effectiveness research, evaluative clinical science, and clinical evaluation (Lohr, 1988; Relman, 1988; Gelijns, 1990; Wennberg, 1990~. Effeciiveness research has become an important concept in the rapidly evolving field of technology assessment, which in the past has focused on studies of clinical efficacy)
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to establish the Patient Outcomes Assessment Research Program. Through this program, NCHSR funded a set of multidisciplinary research studies, focused on particular clinical conditions, to assess the outcomes and effectiveness of alternative health care interventions.
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In addition to its directives regarding AHCPR, the legislation directed the Secretary of Health and Human Services to call on the IOM to recommend priorities for the assessment of specific health care technologies. In asking the IOM to conduct this study, and in keeping with the legislation, the agency proposed that the IOM effort focus specifically on developing a process for setting priorities for technology assessment and reassessment within OHTA.
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From page 22... ...
To carry out its mandate, the council established panels on methods of technology assessment, on information dissemination, and on evaluation. In response to a request from the director of the National Center for Health Services Research, the council charged its evaluation panel with setting priorities for technology assessment.
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From page 23... ...
Medical Technology Medical technology encompasses a wide range of items and services that support clinical practice, including "drugs, devices, medical and surgical procedures, and the organizational and supportive systems within which such care is provided" (Office of Technology Assessment [OTAl, 1978~. The term is often defined by example-electronic fetal monitoring, drug therapy, coronary artery bypass surgery, magnetic resonance imaging (MRI)
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From page 25... ...
Reassessment The IOM committee defined the term reassessment literally as a subsequent assessment of a health technology conducted by the same institution or organization that conducted the first assessment. Thus, evaluation of a technology by a second organization would not be considered reassessment, although the information from the first assessment would certainly be weighed as part of any new assessment effort.
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From page 26... ...
The process should also be of value to other organizations that, notwithstanding their differing goals, must develop priorities for the use of limited assessment resources. APPENDIX: THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH The establishment of AHCPR is a reflection of concerns about the rising costs of health care, the effect on health care quality and costs of knowing little about the value of many health care technologies, and He consequences
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From page 27... ...
For example, the Center for Medical Effectiveness Research within AHCPR has incorporated the medical effectiveness studies of the Patient Outcome Assessment Research Program of NCHSR and is now funding a set of condition-focused grants and contracts called Patient Outcomes Research Teams, or PORTs. These multidisciplinary teams use methods for making inferences from expenmental and nonexperimental data to assess all reasonable alternative practices for a specified clinical condition.
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The Center for General Health Services Extramural Research promotes research in three areas: cost and financing, primary care, and technology and quality assessment. The Division of Technology and Quality Assessment supports research that includes development and evaluation of methods for conducting health care technology assessments and identification of factors that influence the development' diffusion, and adoption of health care technologies (DHHS, 1990~.
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It sends formal letters of inquiry to other PHS agencies, particularly the Food and Drug Administration (FDA) , the National Institutes of Health (NIH)
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OHTA sends HCFA a memorandum that states whether coverage is or is not recommended. Although these memoranda are not subject to the Freedom of Information Act and thus are not available to the public, the literature synthesis and analysis are published and widely disseminated in the series AHCPR Health Technology Assessment Reports.
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