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Knowing what Works in Health Care: A Roadmap for the Nation
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Index
A
Aetna, 67, 69-70, 220
Agency for Health Care Policy and Research (AHCPR), 26, 27, 123, 125-126, 138, 139
Agency for Healthcare Research and Quality (AHRQ), 20, 42, 48, 49, 155, 159.
See also National Guideline Clearinghouse
Center for Medical Effectiveness Research, 27
comparative effectiveness methods, 87 n.6, 104
Effective Health Care Program, 28, 43, 60, 61, 72, 76, 83, 104, 164, 189
Evidence-based Practice Centers (EPCs), 20, 27, 44, 46-47, 59, 60, 61, 64, 65, 66-67, 68, 83, 84, 91, 133, 186, 189, 190
funding for, 157
identifying potential topics, 61, 62, 64, 66-67, 72, 76, 164, 186
research grants, 109
statutory limitations on, 61
template for submission of topics, 193-198
updating guidelines, 111, 138
Alzheimer’s disease, 20, 88, 92, 181, 182, 183
Ambulatory Care Quality Alliance, 48
America’s Health Insurance Plans, 27, 28, 48
American Academy of Audiology, 65
American Academy of Family Physicians, 48, 65
American Academy of Neurology, 85, 103, 136
American Academy of Orthopedic Surgeons, 65
American Academy of Pediatrics (AAP), 65, 122-123
American Association of Clinical Chemistry, 65
American Association of Health Plans, 27
American Board of Medical Specialties, 187
American College of Cardiology (ACC), 20, 46, 65, 85, 103, 134-135, 136, 139, 186
American College of Chest Physicians (ACCP), 65, 85, 103, 135, 136
American College of Obstetricians and Gynecologists, 65
American College of Physicians (ACP), 65, 85, 123, 135
Clinical Efficacy Assessment Project, 26, 46
performance measurement, 48
Physicians’ Information and Education Resource, 47
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American Dental Association, 65
American Diabetes Association, 46, 135
American Dietetic Association (ADA), 46, 65
American Heart Association (AHA), 20, 46, 83, 85, 103, 135, 136, 139, 186
American Medical Association (AMA), 20, 27, 187
American Organization of Nurse Executives, 65
American Society for Therapeutic Radiology and Oncology, 134
American Society of Clinical Oncology (ASCO), 46, 65, 85, 134
American Urological Association, 134
Appraisal of Guidelines Research and Evaluation (AGREE) Instrument, 136-137, 155, 231-232
AQA Alliance, 48
Australia, national programs, 124, 160, 161, 162, 163
Autologous bone marrow transplant, 64-65, 68
B
Back pain, 68, 69, 70, 95, 96, 139, 157
Benchmarks of appropriate care, 39, 40, 43
Bevacizumab (Avastin®) for age-related macular degeneration, 20, 92, 183
Bias.
See also Conflicts of interest
attrition, 98
defined, 8, 97, 154 n.1
detection/ascertainment, 98
information, 98
intellectual, 75, 129-130, 143, 144, 145, 158
minimizing, 91, 97-98, 129-132, 139, 142-146, 157, 159
performance, 98
publication, 97, 101, 159
reporting, 97, 98, 158
selection, 98
statistical, 8
Blue Cross and Blue Shield Association (BCBSA), 28
Technology Evaluation Center (TEC), 20, 26, 43, 44, 59, 60, 62, 67, 69-70, 71, 84, 85, 189
Breast cancer, 64-65, 68, 69, 72, 77, 92, 95, 96, 137
Burden-of-disease criterion, 6, 11, 13, 71-72, 73, 74, 76, 172-173, 197
C
Canada, national program, 28, 71, 102, 123, 124, 160, 161, 162, 163, 215
Canadian Agency for Drugs and Technologies in Health (CADTH), 71, 162, 215
Canadian Task Force on the Periodic Health Examination, 28, 123
Cardiovascular care, 46, 51, 68, 82, 95, 96, 103, 135, 186
Case-control studies, 4, 23, 24, 91, 92, 223
Case series, 4, 23, 24, 91, 92, 102, 103
Center for Biologics Evaluation and Research, 42
Center for Devices and Radiological Health, 42
Center for Drug Evaluation and Research (CDER), 42
Center for Medical Effectiveness Research, 27
Centers for Disease Control and Prevention, 42, 65, 83-84, 206, 217
Centers for Medicare & Medicaid Services (CMS), 64, 65, 188, 21
coverage determinations, 51, 59-61, 93, 94, 95
database, 216-217
expenditures on health services, 37, 38, 39, 50-51, 163
Medicare Coverage Advisory Committee (MCAC), 27, 45
Medicare Evidence Development and Coverage Advisory Committee (MedCAC), 27, 45, 59-60, 62, 71, 75, 83, 84
regional differences in spending, 38, 39
utilization of evidence assessments, 26, 27, 28, 44, 45, 83, 84
Cervical cancer, 70, 94, 96, 205-217
Chalmers, Iain, 81, 86
Cholesterol reduction, 50, 68
Chronic obstructive pulmonary disease, 63, 66, 95
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CINHAL (Cumulative Index to Nursing & Allied Health Literature), 99
Clinical effectiveness
defined, 22-24
evidence of, see Evidence of effectiveness
Clinical Effectiveness Advisory Board, 10-11, 13, 153, 171, 172-173
Clinical effectiveness research.
See also Systematic reviews
challenges, 47, 49-52
conflicts of interest in, 25, 97
context for, 34-36
current landscape, 5-6, 41-52
duplication of effort, 5, 6, 51-52, 66-68, 69-70, 73, 156
estimate of effect, 101
evidence base, 35-36, 92-94, 127
external validity, 101
grading systems for strength of evidence, 7, 9, 49, 108, 123, 134
health policy challenges and, 36-41
individual studies and, 82-83
information needs, 47, 49
key players, 42-47
performance measurement, 40, 43, 47, 48, 122, 137, 147
political pressures, 157
quality of evidence, 90, 93-94, 100-104, 108, 159
strength of findings, 101, 108
subpopulations, 8, 59, 61, 93, 94, 96, 105, 166, 199, 200, 202
synthesis of available evidence, 25, 42, 43-45
transparency, 7, 49-50, 51
Clinical practice guideline development
adherence to standards in, 11, 15, 121, 122, 124, 139-140, 142, 146-147, 155
AGREE Instrument, 231-232
benefit assessments, 128-129, 142
bias, 11, 15, 121, 122, 129-132, 136, 139, 140, 142-146
COGS Checklist, 233-235
comorbidities and, 48
conflicts of interest, 11, 15, 121, 122, 124, 130-132, 140, 142-146, 154
consensus building, 9, 134-135, 140, 141
continuum, 3, 4, 22, 23
current landscape, 8-9, 121, 125-138
defined, 125
developers, 8, 26, 43, 45-47, 61, 124-125, 132-133
efficiency and timeliness, 121, 122, 140-141
expert opinion vs. empirical evidence, 41, 124, 125, 127
external review, 141, 147
gaps and overlaps, 8, 134, 140-141, 156
grading strength of recommendations, 49, 90, 123, 128, 129, 132-133, 135-136, 140, 141-142, 146, 234
historical context for, 24-25, 26-28, 122-123
improving current guidelines, 134-137, 139
information quality, 8-9, 36, 126-132
language standardization, 126, 141-142, 146-147, 167
limitations of, 8-9, 121, 138, 165-166
methodological rigor, 15, 127-129, 130, 139, 165
multiple conflicting guidelines, 126, 133-134, 138, 140-141
objectivity, 50-51, 121, 122, 127, 128-129, 139, 140, 165
panel composition, 121, 129-130, 134-135, 140, 143, 144, 145-146
quality issues, 9, 12, 47, 123, 125-132, 135, 142, 153, 154
recommendations, 11, 15, 121, 139, 145, 146, 173
resource requirements, 124, 126, 156
standardization and consistency in, 11, 121, 126, 134, 135-137, 139-142, 146-147, 231-235
systematic reviews and, 83, 85, 105, 111, 123, 127, 133, 134
transparency, 11, 50, 121, 125, 126, 139-140, 144, 147
updating/currency, 124, 125, 138, 140-141
USPSTF model, 8, 45-47, 94, 123, 124, 125, 132-133, 139, 186, 191
Cochrane Central Register of Controlled Trials, 99, 112
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Cochrane Collaboration, 20, 25, 27, 43, 44, 61, 62, 72, 73, 84, 86, 99, 101, 102, 104, 111, 155, 158, 189
Cochrane Library, 36, 44, 84, 215
Cohort studies, 24, 91, 92, 102, 103, 226
Comorbidities, 3, 48, 49, 88, 90, 94-95, 138
Comparative effectiveness research, 19, 22, 24, 25, 43, 83
Conference on Guidelines Standardization (COGS) Checklist, 136, 137, 233-235
Conflicts of interest.
See also Bias
in clinical effectiveness research, 25, 97
federal guidelines, 131-132
financial, 50-51, 130-132, 143, 144, 145, 154, 157-158
guidance for managing, 158
individual-level, 132, 140, 143, 145
in information, 143-145
organizational-level, 132, 140, 143, 144, 146
panel-level, 11, 130-131, 140, 143, 145-146
in priority setting, 57, 75
public disclosure, 132, 140, 143, 146
restrictive measures, 50, 125, 143-145
Consolidated Standards for Reporting Trials (CONSORT), 105, 106-107, 159
Consumer-directed health care, 1, 2-3, 5, 21, 40
Consumers Union’s Best Buy Drugs Program, 20, 186
Cost criteria for priority setting, 6, 11, 13, 71, 72, 73, 74, 76, 133, 173, 174, 197, 232
Cost-effectiveness analysis, 19, 27, 71, 72, 73, 161, 162, 163, 174, 195, 207, 214, 226, 228
Costs of health care, 1, 3, 17-18, 19, 27, 33, 34-35, 36, 40, 44, 45, 67, 160, 197
Medicare expenditures, 37, 38, 39, 50-51, 163
Council of Linkages Between Academia and Public Health Practice, 65
Council of Medical Specialty Societies, 27, 187
Cross-sectional studies, 4, 23, 24
D
Dartmouth-Hitchcock Department of Orthopedic Surgery, 20-21, 190
Decision modeling/support, 27, 51, 58, 95, 122, 129, 137
Delivery of health services, variation in, 13, 34, 38
Delphi technique, 5, 58
Denmark, national program, 161
Depression, 63, 66, 67, 69, 72, 85, 96
Device evaluation, 24, 26, 42, 43, 62, 70, 83, 92, 93, 158, 161, 162, 189, 190, 218, 229
Diabetes mellitus, 46, 63, 72, 92, 96, 107, 135, 221, 227
Drug Effectiveness Review Project (DERP), 45, 60, 62, 63, 71
Drug evaluation, 42-43, 45, 50, 93, 161-163
Duke University, 86
Duplication of efforts, 5, 6, 51-52, 66-68, 69-70, 73, 156
E
ECRI Institute, 20, 26, 43, 60, 67, 69-70, 84, 111, 112, 190
quick turnaround reports, 44, 205-217
Effective Health Care Program, 28
Effectiveness. See Clinical effectiveness
EMBASE (Excerpta Medica), 99, 100, 110, 112, 218, 220
End-of-life care, 2, 13, 18, 38, 59, 66, 76, 190
Epilepsy guidelines, 134
Erythropoietin, 50-51
European Network for Health Technology Assessment, 160
Evidence assessment. See Clinical effectiveness research;
Priority setting for evidence assessment;
Systematic reviews
Evidence of effectiveness, defined, 3, 21
as selection criterion, 6, 9, 71, 72, 90-92
Experimental studies.
See also Randomized controlled trials
defined, 24
value of, 7, 100
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F
Federal Food, Drug, and Cosmetic Act, 26
Fogarty International Center for Advanced Study in the Health Sciences, 65
France, national program, 161
G
Germany, national program, 161
Grading systems for strength of evidence, 49, 90, 108, 123, 128, 129, 1321 33, 135-136, 140, 141-142, 146, 234
Guideline(s), 2, 3, 4, 5, 8-9, 10, 11, 12, 14, 15, 17, 19-20, 22, 23, 24-25, 26-28, 36, 41, 43-44, 45-47, 48, 49, 50-51, 59, 61, 63, 67, 68, 76, 83, 85, 86, 88, 90, 94, 102, 103, 104, 107, 111, 121-153, 154, 155, 156, 157, 158, 162, 163, 164, 165-172, 173, 174, 186, 191, 203, 220, 231-235.
See also Clinical practice guideline development
H
Harmful or ineffective interventions, 3, 5, 26, 37, 41, 47, 50-51, 64-65, 68, 73, 81, 82, 88, 89, 91, 92, 93, 94, 96, 97, 99, 101, 105, 110, 123, 128, 129, 132, 138, 142, 234
Hayes, Inc., 43, 44, 60, 67, 69-70, 84, 85, 111, 112, 218-229
Health care decision maker, defined, 21-22
Health plan coverage.
See also Centers for Medicare & Medicaid Services
decisions, 5, 33, 140
experimental or investigational services, 41
FDA approval and, 41
medical necessity, 41, 51
priorities for evidence reviews, 72-73
synthesis of evidence for, 43, 83, 85
Health Plan Employer Data and Information Set, 48, 187
Health policy challenges, 36
consumer-directed care, 5, 33, 40
costs of health care, 3, 33, 37
coverage decisions, 5, 33, 41
geographic variation in utilization, 5, 33, 37-40
quality of care, 5, 33, 40
Hierarchies of evidence, 7, 102-104, 108, 136
Horizon scanning, 63-70, 74
Hypertension, 8, 36, 51, 63, 67, 107, 133, 134
I
Identifying effective services.
See also Priority setting for evidence assessment
charge to committee, 1, 2, 17, 18
conceptual framework, 2-3, 21-24
international approaches, 8, 84, 160-164
milestones, 25, 26-28
Innovations in health care.
See also Technology assessments
funding for research, 41-42
horizon scanning for, 63-71
ineffective or harmful interventions, 64-65, 68
pace of, 34, 35
systematic reviews of new and emerging technologies, 111-112
Institute of Medicine (IOM), 28
Committee on Conflict of Interest in Medical Research, Education, and Practice, 158
Committee on Priorities for Assessment and Reassessment of Health Care Technologies, 58, 155
Committee on Quality of Health Care in America, 155
Committee on Setting Priorities for Guidelines Development, 155
Committee to Advise the Public Health Service on Clinical Practice Guidelines, 130
reports with recommendations related to priority setting, 59 n.1
Insurance. See Health plan coverage
International initiatives, 84, 124, 135-136, 137.
See also Cochrane Collaboration;
individual countries
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J
John M. Eisenberg Clinical Decisions and Communications Science Center, 43
Johnson & Johnson, 20, 190, 219-220
Joint Commission, 20, 48, 147, 187
Journals
standards for reporting systematic reviews, 105-108, 159, 199-203
Strength of Recommendation Taxonomy, 135-136
K
Kaiser Permanente, 44, 67, 69-70
Kefauver-Harris Drug Amendments, 26
Knowledge transfer issues, 19
L
Language/terminology standards, 7, 9-10, 11, 14, 81, 104, 108, 126, 141-142, 146-147, 155-156, 159, 167, 171, 172, 173
Latin American Caribbean Health Sciences Literature (LILACS), 99
Literature reviews, 86-87
Lung cancer, 66, 92, 94, 96
M
Macular degeneration, 20, 68, 92, 95, 182, 183
Mathematical modeling, 95
Medicaid, 37, 38, 45, 60, 62, 163, 197.
See also Centers for Medicare & Medicaid Services
Medical Device Amendments, 26
Medical Services Advisory Committee (Australia), 162
Medicare and Medicaid. See Centers for Medicare & Medicaid Services
Medicare Payment Advisory Commission, 19, 28, 154
Medicare Prescription Drug, Improvement, and Modernization Act of 2003, 28, 43
MEDLINE, 35, 98, 99, 100-101, 110, 112, 218, 220, 225
Meta-analyses
analytic considerations, 104
defined, 24, 82
journal standards for reporting, 105, 159, 199-203
origins, 85, 86
producers, 43
synthesis of systematic reviews, 7, 82, 102, 104
Meta-analysis Of Observational Studies in Epidemiology (MOOSE), 105-108, 159, 202-203
Myocardial infarction, 38, 51, 66, 68, 82
N
National Center for Biotechnology Information, 36
National Center for Health Care Technology, 26
National Center of Complementary and Alternative Medicine, 65
National Cholesterol Education Program, 133, 135
National clinical effectiveness assessment program
accountability, 12, 155, 156, 167
administrative structure, 165, 170
alternative approaches compared, 153, 164-170
central agency model, 153, 165, 166-170
consistency, 12, 155-156, 160, 167
efficiency, 12, 156-157, 168
evaluation of Program, 172-173
feasibility, 12, 156, 157, 168
guiding principles, 12, 74, 154-159
hybrid model, 153, 165, 166-170
independent forum, 171-172
international experiences, 160-164
mission and functions, 1-2, 9-10, 19, 165
objectivity, 12, 75-76, 156, 157-158, 168
recommendations for infrastructure building, 1-2, 9-12, 58, 170-173
responsiveness, 12, 158, 169
scientific rigor, 12, 159, 160, 169, 170
status quo compared to, 153, 155, 164-166, 167-169
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transparency, 12, 159, 160, 163, 169
unanswered questions about, 173-174
National Committee for Quality Assurance (NCQA), 20, 48, 147, 187
National Guideline Clearinghouse (NGC), 8, 27, 36, 45, 124, 126, 133-134, 138, 215
National Health Service (UK), 62, 161
National Heart, Lung, and Blood Institute (NHLBI), 46, 133, 135
National Horizon Scanning Centre (UK), 62, 162
National Institute for Health and Clinical Excellence (NICE) (UK), 62, 71, 124, 135, 161, 162
National Institutes of Health (NIH), 35 n.1, 36, 51, 65, 99 n.11, 183
clinical guideline development, 133, 143
conflicts of interest, 50, 131, 143
Consensus Development Program, 45, 59, 60, 62, 83, 133
funding/budget, 41, 42
Office of Dietary Supplements, 65
Office of Management Analysis and Review, 65, 71
Office of Medical Applications of Research (OMAR), 63, 71
Office of Research on Women’s Health, 65
research training programs, 109
systematic reviews, 59
National Library of Medicine, 35 n.1, 36, 99 n.11, 214
National Quality Forum (NQF), 20, 48, 155, 187
National Rural Health Association, 65
New-evidence criterion, 6, 71, 72, 73, 77, 111, 141, 158
O
Objectivity
in guideline development, 50-51, 121, 122, 127, 128-129, 139, 140, 165
in priority setting, 75-76
in systematic reviews, 6, 7, 86, 157, 165
Observational or nonexperimental studies
defined, 24
journal reporting standards for meta-analyses, 105, 159, 202-203
quality of, 101, 109
value of, 7, 91
Outcomes of health care
expenditures and, 39
negative effects of approval, 51, 64-65, 68
racial/ethnic disparities as selection criterion, 73, 77, 88, 91
Overviews, 85-86
Oxford Database of Perinatal Trials, 86
P
Pay-for-performance incentives, 40, 122
Pearson, Karl, 86
Performance measurement
adherence to clinical practice guidelines, 122, 137, 147
basis for, 40, 43
organizations, 47, 48
Pharmaceutical Benefits Advisory Committee (Australia), 162, 163
Pharmaceutical Research and Manufacturers of America (PhRMA), 42
Physician Consortium for Performance Improvement, 20, 187
PICO format, 87-88
Positron emission tomography
for Alzheimer’s disease, 20, 88, 92, 181, 182, 183
Potential impact criterion, 71, 72
Preventive services
analytic framework for systematic reviews, 89-90, 92
study designs, 7, 91, 92
for subpopulation, 94, 96
topic nominations, 63, 64, 66, 94, 96
USPSTF recommendations, 8, 45-47, 94, 123, 125, 132-133, 186, 191
Priority Setting Advisory Committee (PSAC), 13
composition and size, 13-14
meeting frequency, 77
membership, 13, 57, 74-75
mission, 73, 165, 170
nomination process, 14
scope of topics, 76
transparency, 76
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Priority setting for evidence assessment
basic principles, 57, 74, 75-76
conflicts of interest, 57, 75
contexts for, 2-3, 59-61
horizon scanning, 63-70, 74
identifying topics, 5, 13, 57, 61-71, 76-77, 161
methods, 5-6, 14, 58, 59, 61-72, 75-76
recommendations, 13-14, 73-77, 172-173
responsiveness, 75
selection criteria for high-priority topics, 5, 6, 11, 13, 57, 58, 71-72, 73, 74, 76-77, 172-173, 197
sources of nominations, 61, 64, 65, 74
standardization of procedures, 75-76
for systematic reviews, 13-14, 62-63
template for submission of topics to AHRQ, 193-198
topics nominated, 61, 64, 66-67, 72
updating priorities and processes, 73, 75, 77
Professional societies.
See also individual societies
clinical practice guideline development, 2, 8, 12, 22, 43, 45, 47, 111, 124, 125, 126, 134, 139, 170
conflicts of interest, 144
evidence assessments, 51, 60, 61, 156
intellectual bias, 75, 129-130
“ownership” of medical conditions, 134
quality of guidelines, 125, 139
topic nominations, 63, 64, 193-198
Prostate cancer, 22, 69, 88, 92, 94, 95, 96, 134
Public controversy criterion, 6, 71, 72
Public/provider interest criterion, 71, 72
PubMed database, 36, 84, 209-214, 225
Q
Quality of health care, 1, 2, 5, 21, 122
IOM aims for patient care, 40
Quality of life, 51, 72, 88, 133
Quality of Reporting of Meta-analyses (QUOROM), 105-108, 159, 199-201
R
RAND Corporation, 26, 130
Randomized controlled trials (RCTs), 4, 7, 23, 24, 25, 35, 90, 91, 92, 97, 99, 100, 102, 103, 104, 105, 106, 109, 159, 199-201, 207, 208, 218, 223, 224, 227
Ranibizumab (Lucentis®) for age-related macular degeneration, 20, 92, 183
Rare and orphan diseases, 48-49, 134, 141
Recommendations
clinical practice guideline development, 11, 15, 121, 139, 145, 146, 173
national clinical effectiveness assessment program, 9-12, 73-77, 170-173
systematic reviews, 11, 13-15, 81-82, 108-110, 173
Robert Wood Johnson Foundation (RWJF), 1, 18, 19
S
Saliba Burns Institute, 65
Scientific rigor, 15, 127-129, 130, 139, 165
Scope of this study, 18-20
Scotland, national program, 161, 163
Scottish Intercollegiate Guidelines Network, 103, 124, 126, 163
Scottish Medicines Consortium, 161, 163
Selection criteria
for high-priority topics, 5, 6, 11, 13, 57, 58, 71-72, 73, 74, 76-77, 172-173, 197
for systematic reviews, 89-92, 110, 127
Singapore, national program, 160
Society of Vascular Surgery, 65
Spinal Cord Consortium, 65
Stakeholders, 13-14, 25, 48, 51, 74-75, 132, 135, 144, 185, 190-191
Standards for Reporting of Diagnostic Accuracy (STARD), 105
State Children’s Health Insurance Program, 163
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), 105
Stroke guidelines, 8, 63, 67, 68, 133-134
Study methods, 20-21
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Subpopulations, 8, 59, 61, 93, 94, 96, 105, 138, 166, 199, 200, 202
Substance Abuse and Mental Health Services Administration (SAMHSA), 83, 84
Synthesis of results of studies, 7-8, 45, 49, 82, 104-108, 109, 110, 126-132.
See also Meta-analyses
Systematic reviews
analytic framework, 89-95
appraising evidence, 100-104, 110
availability of evidence, 93-94
best-evidence approach, 91, 92, 98
bias, 7, 8, 91, 97-98, 100, 102, 108, 158, 159
and clinical practice guideline development, 83, 85, 105, 111, 123, 127, 133, 134
data extraction errors, 102
database searches, 98-99, 101
defined, 3, 24, 82-83
fundamentals, 14-15, 87-108
hand searches, 99-100
hierarchies of evidence, 7, 102-104, 108
international efforts, 84
journal standards for reporting, 105-108, 155, 159, 199-203
language/terminology standards, 7, 9-10, 11, 14, 81, 104, 108, 146, 155-156, 159, 166, 171, 172, 173
methods, 6-8, 14-15, 81, 85-87, 109, 110, 154, 159
new and emerging technologies, 6, 111-112, 166
number annually, 58, 59
objectivity, 6, 7, 86, 157, 165
origins, 85-87
priority setting for, 13-14, 62-63
producers and users, 43, 46-47, 61, 83-85, 133, 156-157, 186
public access to, 84, 155
quality issues, 6-8, 49, 81, 86, 100-104, 108, 123, 127, 134, 153, 154, 159, 165-166
question formulation, 87-88, 92
recommendations for, 11, 13-15, 81-82, 108-110, 173
research workforce, 8, 11, 14-15, 36, 82, 109-110
resource requirements, 124
searching for evidence, 95-100, 127
selection criteria for studies, 89-92, 110, 127
sources of evidence, 86, 94-95, 98-100
standards, 14, 81, 100, 108, 155-156, 159, 199-203
subscription fees, 84
synthesis of results of studies, 7-8, 45, 49, 82, 104-108, 109, 110, 126-132, 159;
see also Meta-analyses
transparency, 7, 49-50, 51, 86, 104, 105, 155, 159
updating, 73, 111, 158
value of, 3, 6-8, 82, 83
T
Technology assessments
defined, 24
milestones, 25, 26
priority setting, 6
producers, 43, 44, 163
Transatlantic Inter-Society Consensus, 65
Transparency
in guideline development, 11, 50, 121, 125, 126, 139-140, 144, 147
in systematic reviews, 7, 49-50, 51, 86, 104, 105
U
Union County Health Committee, 65
United Kingdom, national program, 161-163
UnitedHealthcare, 20, 66, 67-68, 189
University of California at Los Angeles, 130
Up-to-Date database, 47
U.S. Breastfeeding Committee, 65
U.S. Department of Defense, 42, 163
U.S. Department of Health and Human Services (HHS), 9, 10, 61, 153, 164, 171, 172
U.S. Food and Drug Administration (FDA), 26, 42-43, 50, 51, 64, 83, 84, 93, 112, 131, 143, 207, 216, 218
U.S. Office of Technology Assessment (OTA), 26, 27
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U.S. Preventive Services Task Force (USPSTF), 8, 20, 27, 28, 45-46, 47, 60, 61, 62, 65, 71, 72, 83, 84, 89-90, 93-94, 96, 123, 125, 128, 132-133, 135, 139, 186, 191
U.S. Public Health Service, 46
Utilization of health services
benchmarks for optimal use, 39-40
geographic variation in, 5, 37-40
insurance coverage and, 51
and outcomes, 39
variation as selection criterion, 6, 71, 72, 73, 76-77
Utilization Review Accreditation Commission, 147
V
Veterans Health Administration (VHA), 26, 42, 83, 84, 103, 136, 163
W
Web of Science, 99
WellPoint, 67, 69-70
Workforce qualifications and training, 8, 11, 14-15, 36, 82, 109-110
World Health Organization (WHO), Collaborating Center, 44
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