THE LEARNING HEALTH SYSTEM SERIES
ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE
LEARNING WHAT WORKS
Infrastructure Required for
Comparative Effectiveness Research
Workshop Summary
LeighAnne Olsen, Claudia Grossmann, and J. Michael McGinnis
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by the Agency for Healthcare Research and Quality, America’s Health Insurance Plans, AstraZeneca, Blue Shield of California Foundation, Burroughs Wellcome Fund, California Health Care Foundation, Centers for Medicare & Medicaid Services, Charina Endowment Fund, Department of Veterans Affairs, Food and Drug Administration, Johnson & Johnson, sanofi-aventis, and Stryker. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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International Standard Book Number-10: 0-309-12068-3
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Copyright 2011 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
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Suggested citation: IOM (Institute of Medicine). 2011. Learning What Works: Infrastructure Required for Comparative Effectiveness Research: Workshop Summary. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE*
Denis A. Cortese (Chair), Emeritus President and Chief Executive Officer, Mayo Clinic; Foundation Professor, ASU
Donald Berwick, Administrator, Centers for Medicare & Medicaid Services (ex officio)
David Blumenthal, National Coordinator, Office of the National Coordinator for Health IT (ex officio)
Bruce G. Bodaken, Chairman, President, and Chief Executive Officer, Blue Shield of California
David R. Brennan, Chief Executive Officer, AstraZeneca PLC
Paul Chew, Chief Science Officer and CMO, sanofi-aventis U.S., Inc.
Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality (ex officio)
Michael J. Critelli, Former Executive Chairman, Pitney Bowes, Inc.
Helen Darling, President, National Business Group on Health
Thomas R. Frieden, Director, Centers for Disease Control and Prevention (designee: Chesley Richards) (ex officio)
Gary L. Gottlieb, President and CEO, Partners HealthCare System
James A. Guest, President, Consumers Union
George C. Halvorson, Chairman and Chief Executive Officer, Kaiser Permanente
Margaret A. Hamburg, Commissioner, Food and Drug Administration (ex officio)
Carmen Hooker Odom, President, Milbank Memorial Fund Board
Ardis Hoven, Board Chair, American Medical Association
Brent James, Chief Quality Officer and Executive Director, Institute for Health Care Delivery Research, Intermountain Healthcare
Michael M. E. Johns, Chancellor, Emory University
Craig Jones, Director, Vermont Blueprint for Health
Cato T. Laurencin, Vice President for Health Affairs, Dean of the School of Medicine, University of Connecticut
Stephen P. MacMillan, President and Chief Executive Officer, Stryker
Mark B. McClellan, Director, Engelberg Center for Healthcare Reform, The Brookings Institution
Sheri S. McCoy, Worldwide Chairman, Johnson & Johnson Pharmaceuticals Group
Elizabeth G. Nabel, President, Brigham and Women’s Hospital
________________
* Formerly the Roundtable on Evidence-Based Medicine. Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
Mary D. Naylor, Professor and Director of Center for Transitions in Health, University of Pennsylvania
Peter Neupert, Corporate Vice President, Health Solutions Group, Microsoft Corporation
William D. Novelli, Former CEO, AARP; Professor, Georgetown University
Jonathan B. Perlin, Chief Medical Officer and President, Clinical Services, HCA, Inc.
Robert A. Petzel, Under Secretary, Veterans Health Administration (ex officio)
Richard Platt, Professor and Chair, Harvard Medical School and Harvard Pilgrim Health Care
John C. Rother, Group Executive Officer, AARP
John W. Rowe, Professor, Mailman School of Public Health, Columbia University
Susan Shurin, Acting Director, National Heart, Lung, and Blood Institute (ex officio)
Mark D. Smith, President and CEO, California HealthCare Foundation
George P. Taylor, Assistant Secretary for Health Affairs (Acting), Department of Defense (designee: Michael Dinneen) (ex officio)
Reed D. Tuckson, Executive VP and Chief of Medical Affairs, UnitedHealth Group
Frances M. Visco, President, National Breast Cancer Coalition
Workshop Planning Committee
John W. Rowe (Chair), Mailman School of Public Health, Columbia University
Stuart H. Altman, Brandeis University
Kathleen A. Buto, Johnson & Johnson
Carolyn M. Clancy, Agency for Healthcare Research and Quality
W. David Helms, AcademyHealth
Mark B. McClellan, Brookings Institution
Peter R. Orszag, Congressional Budget Office
Roundtable Staff
Christie Bell, Financial Associate
Patrick Burke, Financial Associate (until December 2009)
Andrea Cohen, Financial Associate (until December 2008)
Claudia Grossmann, Program Officer
Kiran Gupta, Research Assistant (until May 2009)
Katie Jakubs, National Institutes of Health detailee
J. Michael McGinnis, Senior Scholar and Executive Director
LeighAnne Olsen, Program Officer
Daniel O’Neill, Research Associate (until December 2008)
Stephen Pelletier, Consultant
Brian Powers, Senior Program Assistant
Valerie Rohrbach, Program Assistant
Julia Sanders, Program Assistant
Robert Saunders, Program Officer
Ruth Strommen, Intern
Leigh Stuckhardt, Program Associate
Kate Vasconi, Senior Program Assistant (until January 2011)
Pierre Yong, Program Officer (until May 2010)
Catherine Zweig, Senior Program Assistant (until June 2010)
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
Barbara Alving, National Institutes of Health
Meryl Bloomrosen, American Medical Informatics Association
Jean Paul Gagnon, sanofi-aventis
Larry A. Green, University of Colorado at Denver
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Samuel Nussbaum, Wellpoint, Inc. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Institute of Medicine
Roundtable on Value & Science-Driven Health Care1
Charter and Vision Statement
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public–private cooperation for change.
******************************************
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. We seek the development of a learning health system that is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care, and to ensure innovation, quality, safety, and value in health care.
Vision: Our vision is for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nation’s health.
Goal: By the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. We feel that this presents a tangible focus for progress toward our vision, that Americans ought to expect at least this level of performance, that it should be feasible with existing resources and emerging tools, and that measures can be developed to track and stimulate progress.
Context: As unprecedented developments in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented challenges to identify and deliver the care most appropriate for individual needs and conditions. Care that is important is often not delivered. Care that is delivered is often not important. In part, this is due to our failure to apply the evidence we have about the medical care that is most effective—a failure related to shortfalls in provider knowledge and accountability, inadequate care coordination and support, lack of insurance, poorly aligned payment incen-
_______________
1 Formerly the Roundtable on Evidence-Based Medicine.
tives, and misplaced patient expectations. Increasingly, it is also a result of our limited capacity for timely generation of evidence on the relative effectiveness, efficiency, and safety of available and emerging interventions. Improving the value of the return on our healthcare investment is a vital imperative that will require much greater capacity to evaluate high priority clinical interventions, stronger links between clinical research and practice, and reorientation of the incentives to apply new insights. We must quicken our efforts to position evidence development and application as natural outgrowths of clinical care—to foster health care that learns.
Approach: The IOM Roundtable on Value & Science-Driven Health Care serves as a forum to facilitate the collaborative assessment and action around issues central to achieving the vision and goal stated. The challenges are myriad and include issues that must be addressed to improve evidence development, evidence application, and the capacity to advance progress on both dimensions. To address these challenges, as leaders in their fields, Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public–private cooperation for change.
Activities include collaborative exploration of new and expedited approaches to assessing the effectiveness of diagnostic and treatment interventions, better use of the patient care experience to generate evidence on effectiveness, identification of assessment priorities, and communication strategies to enhance provider and patient understanding and support for interventions proven to work best and deliver value in health care.
Core concepts and principles: For the purpose of the Roundtable activities, we define science-driven health care broadly to mean that, to the greatest extent possible, the decisions that shape the health and health care of Americans—by patients, providers, payers, and policymakers alike—will be grounded on a reliable evidence base, will account appropriately for individual variation in patient needs, and will support the generation of new insights on clinical effectiveness. Evidence is generally considered to be information from clinical experience that has met some established test of validity, and the appropriate standard is determined according to the requirements of the intervention and clinical circumstance. Processes that involve the development and use of evidence should be accessible and transparent to all stakeholders.
A common commitment to certain principles and priorities guides the activities of the Roundtable and its members, including the commitment to: the right health care for each person; putting the best evidence into practice; establishing the effectiveness, efficiency, and safety of medical care delivered; building constant measurement into our healthcare investments; the establishment of healthcare data as a public good; shared responsibility distributed equitably across stakeholders, both public and private; collaborative stakeholder involvement in priority setting; transparency in the execution of activities and reporting of results; and subjugation of individual political or stakeholder perspectives in favor of the common good.
Foreword
In its role as adviser to the nation to improve health, the Institute of Medicine (IOM) focuses on ensuring that Americans receive care based on the best scientific knowledge—from identifying key opportunities to better support innovation and discovery in basic research to accelerating the translation of biomedical discoveries into clinical practice and providing guidance on developing the systems and workforce to ensure delivery of the care most appropriate to each patient. In several seminal reports, the IOM has highlighted key shortfalls in the safety, quality, and effectiveness of health care delivered—shortfalls compounded by the unsustainable growth of national healthcare expenditures and the recent strains on the national and global economy. Through convening activities and consensus reports, the IOM has also sought solutions to these issues by gathering stakeholder perspectives on key barriers and opportunities for improvement and by developing recommendations for moving toward a healthcare system driven by evidence and focused on delivering care of greater value to patients.
Convened in 2006, the IOM Roundtable on Value & Science-Driven Health Care has contributed to these discussions and articulated a vision for a learning health system, in which evidence is both applied and generated as a natural course of care. The Roundtable has explored key components of such a system though its Learning Health System series of workshops and publications. A central dimension of the Roundtable’s work toward this long-term goal is expanding the capacity to meet the acute, near-term need for evidence of comparative effectiveness information. Such was the focus of the seventh workshop in the Roundtable’s Learning Health System series, Learning What Works: Infrastructure Required for Comparative Effective-
ness Research. Held on July 30–31, 2008, this workshop gathered experts from across disciplines and sectors to explore the nature of the work required to develop insights on the comparative effectiveness of clinical interventions and care processes and to assess the current and needed capacity to expand and improve this work. This publication presents a summary of the workshop presentations and discussions and provides the beginnings of a roadmap for moving forward, especially important in the context of the passage of the American Recovery and Reinvestment Act (ARRA) of 2009. Included in ARRA is $1.1 billion of federal funds to increase national capacity for clinical effectiveness research, underscoring the pressing nature of the demand and the importance of developing coordinated and efficient capacity for the work needed.
I thank the members of the Roundtable staff for facilitation of Roundtable activities, as well as the sponsors, who make this work possible: the Agency for Healthcare Research and Quality, America’s Health Insurance Plans, AstraZeneca, Blue Shield of California Foundation, Burroughs Welcome Fund, California Health Care Foundation, Centers for Medicare & Medicaid Services, Charina Endowment Fund, Commonwealth Fund, Department of Veterans Affairs, Food and Drug Administration, Johnson & Johnson, sanofi-aventis, and Stryker. I would also like to offer my personal thanks to the Roundtable members themselves for their dedication.
Harvey V. Fineberg, M.D., Ph.D.
President, Institute of Medicine
Preface
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care provides a trusted venue for sustained discussion and collaboration between national experts and health system stakeholders on issues important to improving the generation and application of evidence for healthcare decisions. The Roundtable has set the goal that by 2020, 90 percent of clinical decisions will reflect and be supported by accurate, timely, and up-to-date evidence. Anchoring their work toward this goal is a focus on three dimensions of the challenge:
- Accelerating progress toward the long-term vision of a learning health system, in which evidence is both generated and applied as a natural product of the care process.
- Expanding the capacity to meet the acute, near-term need for evidence of comparative effectiveness to support medical care that is most effective and produces greatest value.
- Improving public understanding of the nature of evidence, the dynamic character of evidence development, and the importance of insisting on medical care that reflects the best evidence.
As illustrated by previous workshops and publications in the Roundtable’s Learning Health System series, the nation’s capacity to develop information on the comparative effectiveness of clinical interventions and care processes falls far short of the need. Evidence development often fails to meet the needs of healthcare decision makers—lacking applicability to the broad patient populations encountered in clinical practice or consid-
eration of individual patient variation and preference. Capacity to capture and analyze clinical data relevant to point-of-care decisions is growing but remains fragmented and inefficient, often due to proprietary or privacy concerns. And systems for synthesizing, translating, and applying evidence to clinical practice remain limited.
To explore and assess the infrastructure needed (e.g., skills, workforce, methods, coordination, information networks) to expand the nation’s capacity to develop and apply comparative effectiveness information, the Roundtable convened the workshop, Learning What Works: Infrastructure Required for Comparative Effectiveness Research. Emerging from discussion at the 2-day workshop was the need for coordinated and tailored infrastructure development efforts that engage key healthcare system stakeholders—patients, providers, policy leaders, information technology experts, health services researchers, health economists, and educators, among others. The discussion highlighted key gaps in current and past work, including the fragmentation and redundancy of clinical effectiveness activities; the need to take better advantage of opportunities provided by emerging health information technologies and of established local and international capacities for evidence development, synthesis, and translation; the need to develop study designs and methods that can keep pace with the development of treatments and diagnostics and support dynamic, real-time approaches to learning; and a growing appreciation for comparative effectiveness research as a discipline, with unique workforce training and skills development needs. Also noted was the counter-productivity of the current balkanization of clinical effectiveness research investments and opportunities provided by public–private collaboration. This publication summarizes the presentations and key discussion points and is rich with insights that are important to inform needed infrastructure development.
We would like to acknowledge those individuals and organizations that donated valuable time toward the development of this workshop summary, including all present at the workshop and the workshop presenters, who not only offered valuable comments but also further developed their presentations into the manuscripts contained within this summary. We would also like to thank those who provided their counsel by serving on the planning committee for this workshop, including Stuart Altman, Ph.D. (Brandeis University); Kathy Buto, M.P.A. (Johnson & Johnson); Carolyn Clancy, M.D. (Agency for Healthcare Research and Quality); David Helms, Ph.D. (AcademyHealth); Mark McClellan, M.D., Ph.D. (Brookings Institution); Peter Orszag, Ph.D. (at the time of the workshop, Congressional Budget Office; currently, Office of Management and Budget); and John Rowe, M.D.
(Chair) (Mailman School of Public Health, Columbia University).1 Roundtable staff, including Katharine Bothner, Lori Burns, Alex Goolsby, Kiran Gupta, Katie Jakubs, LeighAnne Olsen, Daniel O’Neill, Kate Sharaf, Ruth Strommen, and Catherine Zweig, were instrumental in coordinating the 2-day workshop in July 2008 and translating the workshop proceedings and discussion into this workshop summary. We would also like to thank Greta Gorman, Michele de la Menardiere, Abbey Meltzer, Robert Pool, Bronwyn Schrecker, Vilija Teel, Jackie Turner, and Jordan Wyndelts for helping to coordinate the various aspects of review, production, and publication.
The need to improve the effectiveness and value of health care is all the more pressing as economic disparities increase within the United States and globally. The development of methods to reduce costly system inefficiencies and waste and improve outcomes for each individual patient is integral to the sustainability of our healthcare system, and the implementation of infrastructure to support comparative clinical effectiveness research will provide a solid foundation.
|
Denis A. Cortese, M.D. Chair, Roundtable on Value & Science-Driven Health Care |
|
John W. Rowe, M.D. Member, Roundtable on Value & Science-Driven Health Care, and Chair, Workshop Planning Committee |
|
J. Michael McGinnis, M.D., M.P.P. Executive Director, Roundtable on Value & Science-Driven Health Care |
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1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
Contents
1 The Need and Potential Returns for Comparative Effectiveness Research
The Nation’s Need for Evidence on Comparative Effectiveness in Health Care: Learning What Works Best
J. Michael McGinnis, LeighAnne Olsen, Dara Aisner, Pamela Bradley, Daniel O’Neill, and Katharine Bottner
A Vision for the Capacity to Learn What Care Works Best
Mark B. McClellan
The Potential Returns from Evidence-Driven Health Care
Gail R. Wilensky
The Cost and Volume of Comparative Effectiveness Research
Erin Holve and Patricia Pittman
Intervention Studies That Need to Be Conducted
Douglas B. Kamerow
Clinical Data Sets That Need to Be Mined
Jesse A. Berlin and Paul E. Stang
Knowledge Synthesis and Translation That Need to Be Applied
Richard A. Justman
Methods That Need to Be Developed
Eugene H. Blackstone, Douglas B. Lenat, and Hemant Ishwaran
Coordination and Technical Assistance That Need to Be Supported
Jean R. Slutsky
3 The Information Networks Required
Electronic Health Records: Needs, Status, and Costs for U.S. Healthcare Delivery Organizations
Robert H. Miller
Data and Information Hub Requirements
Carol C. Diamond
Integrative Vehicles Required for Evidence Review and Dissemination
Lorne A. Becker
Comparative Effectiveness Workforce—Framework and Assessment
William R. Hersh, Timothy S. Carey, Thomas Ricketts, Mark Helfand, Nicole Floyd, Richard N. Shiffman, and David H. Hickam
Toward an Integrated Enterprise—The Ontario, Canada, Case
Danielle Whicher, Kalipso Chalkidou, Irfan Dhalla, Leslie Levin, and Sean R. Tunis
Information Technology Platform Requirements
Mark E. Frisse
Data Resource Development and Analysis Improvement
T. Bruce Ferguson, Jr., and Ansar Hassan
Practical Challenges and Infrastructure Priorities for Comparative Effectiveness Research
Daniel E. Ford
Transforming Health Professions Education
Benjamin K. Chu
Building the Training Capacity for a Health Research Workforce of the Future
Steven A. Wartman and Claire Pomeroy
Carmella A. Bocchino, Rachel E. Behrman, and William Z. Potter
The Roadmap—Policies, Priorities, Strategies, and Sequencing
Common Themes in Workshop Discussions
Quick Hits—Things That Can Be Done Now
B Comparative Effectiveness Studies Inventory Project
C Comparative Effectiveness Research Priorities: IOM Recommendations (2009)
D Comparative Effectiveness Research Priorities: FCCCER Recommendations (2009)
G Biographical Sketches of Workshop Participants
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* Appendixes A-E are not printed in this book. They are available online at http://www.nap.edu/catalog.php?record_id=12214.
AAAS |
American Association for the Advancement of Science |
AAP |
American Academy of Pediatrics |
AASHTO |
American Association of State Highway and Transportation Officials |
ACA |
Affordable Care Act (2010) |
ACC |
American College of Cardiology |
ACOG |
American Congress of Obstetricians and Gynecologists |
ADHD |
attention deficit hyperactivity disorder |
ADNI |
Alzheimer’s Disease Neuroimaging Initiative |
AF |
atrial fibrillation |
AHA |
American Heart Association or American Hospital Association |
AHC |
academic health center |
AHIP |
America’s Health Insurance Plans |
AHRQ |
Agency for Healthcare Research and Quality |
AIDS |
acquired immunodeficiency syndrome |
ALS |
amyotrophic lateral sclerosis |
AMA |
American Medical Association |
AMCP |
Academy of Managed Care Pharmacy |
AMD |
age-related macular degeneration |
AMI |
acute myocardial infarction |
AQA |
Ambulatory Care Quality Alliance |
ARRA |
American Recovery and Reinvestment Act |
ASC |
active surveillance culturing |
BC |
Biomarkers Consortium |
BMI |
biomedical informatics |
BMS |
bare-metal stent |
CABG |
coronary artery bypass graft |
CADTH |
Canadian Agency for Drugs and Technologies in Health |
CARE ICDJ |
Querying Author about Definition |
CATIE |
Clinical Antipsychotic Trials in Intervention Effectiveness |
CCN |
Cardiac Care Network (Ontario) |
CCR |
Center for Cancer Research |
CDC |
Centers for Disease Control and Prevention |
CDMS |
chronic disease management system |
CDR |
Common Drug Review (Canada) |
CDRH |
Center for Devices and Radiological Health |
CDSR |
Cochrane Database of Systematic Reviews |
CE |
comparative effectiveness |
CEAP |
Committee for Assessment of Diagnostic and Therapeutic Procedures (France) |
CED |
coverage with evidence development |
CENTRAL |
Cochrane Central Register of Controlled Trials |
CEPP |
Committee for Assessment of Devices and Health Technologies (France) |
CER |
comparative effectiveness research |
CEVG |
Cochrane Eyes and Vision Group |
CHD |
coronary heart disease |
CI |
confidence interval |
CIHR |
Canadian Institutes of Health Research |
CIS |
clinical information system |
CMS |
Centers for Medicare & Medicaid Services |
CMTP |
Center for Medical Technology Policy |
CNS |
central nervous system |
COE |
Center for Outcomes and Evidence |
COMPUS |
Canadian Optimal Medication Prescribing and Utilization Service |
COPD |
chronic obstructive pulmonary disease |
COPR |
Council of Public Representatives |
COX |
cyclo oxygenase |
CPI |
Critical Path Initiative |
CPOE |
computerized physician order entry |
CPR |
computer-based patient record |
CPSC |
Consumer Product Safety Commission |
CRG |
Cochrane HIV/AIDS review group |
CRN |
Cancer Research Network |
CS |
computer science |
CT |
computed tomography |
CTSA |
Clinical and Translational Science Awards |
CTSC |
Clinical and Translational Science Center |
DAG |
directed acyclic graph |
DBS |
deep brain stimulation |
DCRI |
Duke Clinical Research Institute |
DEcIDE |
Developing Evidence to Inform Decisions about Effectiveness |
DERP |
Drug Effectiveness Review Project |
DES |
drug-eluting stent |
DHS |
Department of Homeland Security |
DNA |
deoxyribonucleic acid |
DOD |
Department of Defense |
DOE |
Department of Energy |
DSM |
Diagnostic and Statistical Manual of Mental Disorders |
EBM |
evidence-based medicine |
EC |
executive committee |
ECG |
electrocardiogram |
EHR |
electronic health record |
EMEA |
European Medicines Agency |
EMR |
electronic medical record |
EPC |
evidence-based practice center |
EUnetHTA |
European Network for Health Technology Assessment |
FDA |
Food and Drug Administration |
FDAAA |
FDA Amendments Act of 2007 |
FFRDC |
federally funded research and development center |
FNIH |
Foundation for the National Institutes of Health |
FOMC |
Federal Open Market Committee |
FTC |
Federal Trade Commission |
FTE |
full-time equivalent |
FY |
fiscal year |
G-BA |
Federal Joint Committee (Germany) |
GBS |
Guillain-Barré Syndrome |
GCGH |
Grand Challenges in Global Health |
GERD |
gastroesophageal reflux disease |
GIN |
Guidelines International Network |
GKS |
gamma knife surgery |
GPRD |
General Practices Research Data (United Kingdom) |
GRADE |
Grading of Recommendations Assessment, Development, and Evaluation Working Group |
HAI |
hospital acquired infection |
HAS |
Haute Autorité de Santé (France) |
HCDS |
health care delivery system |
HECS |
highly effective clinical services |
HEI |
Health Effects Institute |
HER2 |
human epidermal growth factor receptor 2 |
HHS |
Department of Health and Human Services |
HIMSS |
Health Information Management Systems Society |
HIPAA |
Health Insurance Portability and Accountability Act |
HIT |
health information technology |
HIV |
human immunodeficiency virus |
HMO |
health maintenance organization |
HMORN |
HMO Research Network |
HQA |
Hospital Quality Alliance |
HR |
hazard ratio |
HRT |
hormone-replacement therapy |
HSI |
Homeland Security Institute |
HSR |
health services research |
HSRProj |
Health Services Research Projects in Progress |
HTA |
health technology assessment |
HVI |
Heart and Vascular Institute |
IC |
institute and center |
ICD |
implantable cardiac defibrillator |
ICER |
Institute for Clinical and Economic Review |
ICES |
Institute for Clinical Evaluative Sciences |
IDA |
Institute for Defense Analyses |
IH |
international health |
ILI |
influenza-like-illness |
INHATA |
International Network of Agencies for Health Technology Assessment |
IOM |
Institute of Medicine |
IQWiG |
Institute for Quality and Efficiency (Germany) |
IRB |
institutional review board |
ISO |
independent scientific organization |
IT |
information technology |
JHU |
Johns Hopkins University |
LLNL |
Lawrence Livermore National Laboratory |
LVEF |
left ventricular ejection fraction |
MAS |
Medical Advisory Secretariat |
MCV |
meningococcal conjugate vaccine |
MEDCAC |
Medicare Evidence Development and Coverage Advisory Committee |
MedPAC |
Medicare Payment Advisory Commission |
MI |
myocardial infarction |
MIS |
management information systems |
MIT |
Massachusetts Institute of Technology |
MMA |
Medicare Prescription Drug, Improvement, and Modernization Act |
MOHLTC |
Ministry of Health and Long-Term Care (Ontario) |
MRI |
magnetic resonance imaging |
MRSA |
methicillin-resistant Staphylococcus aureus |
MSAC |
Medical Services Advisory Committee (Australia) |
NAE |
National Academy of Engineering |
NANSAID |
non-aspirin, non-steroidal anti-inflammatory drug |
NAS |
National Academy of Sciences |
NC2D |
National Consortium of Clinical Databases |
NCCN |
National Cancer Care Network |
NCHRP |
National Cooperative Highway Research Program |
NCHS |
National Center for Health Statistics |
NCI |
National Cancer Institute |
NDAI |
National Data Aggregation Initiative |
NGO |
nongovernmental organization |
NHLBI |
National Heart, Lung, and Blood Institute |
NHS |
National Health Service (United Kingdom) |
NICE |
National Institute for Health and Clinical Excellence (United Kingdom) |
NIH |
National Institutes of Health |
NMCES |
National Medical Care Expenditure Survey |
NNSA |
National Nuclear Security Administration |
NRC |
National Research Council |
NRT |
nicotine replacement therapy |
NSAID |
non-steroidal anti-inflammatory drug |
NSF |
National Science Foundation |
NYHA |
New York Heart Association |
NYU |
New York University |
OAI |
Osteoarthritis Initiative |
ODE-I |
Office of Drug Evaluation I |
OFPP |
Office of Federal Procurement Policy |
OHSU |
Oregon Health and Science University |
OHTAC |
Ontario Health Technology Assessment Committee |
OS |
Office of the Secretary |
OSD |
Office of the Secretary of Defense |
OSTP |
Office of Science and Technology Policy |
OTA |
Office of Technology Assessment |
OTC |
over-the-counter |
PACS |
Picture Archiving and Communication System |
PATH |
Program for the Assessment of Technology in Health |
PBAC |
Pharmaceutical Benefits Advisory Committee (Australia) |
PCI |
percutaneous coronary intervention |
PCORI |
Patient-Centered Outcomes Research Institute |
PCR |
polymerase chain reaction |
PDUFA |
Prescription Drug Use Fee Act |
PET |
positron emission tomography |
POC |
point of care |
PPP |
public–private partnership |
PSA |
prostate-specific antigen |
PSAC |
Priority Setting Advisory Committee |
PTSD |
post-traumatic stress disorder |
QI |
quality improvement |
QIO |
quality improvement organization |
R&D |
research and development |
RCT |
randomized controlled trial or randomized clinical trial |
RNI |
radionuclide imaging |
RWJF |
Robert Wood Johnson Foundation |
S&T |
science and technology |
SBU |
Swedish Council on Technology Assessment in Health Care |
SEER |
Surveillance, Epidemiology and End Results |
SES |
socioeconomic status |
SHRPII |
Strategic Highway Research Programs II |
SNOMED |
Systematized Nomenclature of Medicine |
SPARQL |
SPARQL Protocol and RDF Query Language |
SSNDI |
Social Security National Death Index |
SSRI |
selective serotonin reuptake inhibitor |
STEMI |
ST-segment elevation myocardial infarction |
STPI |
Science and Technology Policy Institute |
STS |
Society of Thoracic Surgeons |
SUNY |
State University of New York |
TAB |
Technology Assessment Board |
TAPP |
transabdominal pre-peritoneal |
TCA |
tricyclic antidepressant |
TEC |
Technology Evaluation Center |
TEP |
totally extraperitoneal |
TGA |
Therapeutic Goods Administration (Australia) |
THETA |
Toronto Health Economics and Technology Assessment Collaboration |
tPA |
tissue plasminogen activator |
TRB |
Transportation Research Board |
UAB |
University of Alabama at Birmingham |
UC |
University of California |
UMLS |
unified medical language system |
UNC |
University of North Carolina |
URI |
upper respiratory infection |
USPSTF |
U.S. Preventive Services Task Force |
USQA |
U.S. Quality Algorithms |
USRDS |
U.S. Renal Data System |
VA |
Department of Veterans Affairs |
VATAP |
VA Technology Assessment Program |
VBID |
value-based insurance design |
VHA |
Veterans Health Administration |
VSD |
Vaccine Safety Datalink |
WHO |
World Health Organization |