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Improving Consensus Development for
Health Technology Assessment:
An International Perspective
Clifford Goodman and Sharon R. Baratz, editors
Council on Health Care Technology
Institute of Medicine
National Academy Press Washington, D.C.
1990
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The INSTITUTE OF MEDICINE was chartered in 1970 by the
National Academy of Sciences to enlist distinguished members of
the appropriate professions in the examination of policy matters per-
taining to the health of the public. In this, the Institute acts under
both the Academy's 1863 congressional charter responsibility to be
an advisor to the federal government and its own initiative in identi-
fying issues of medical care, research, and education.
The COUNCIL ON HEALTH CARE TECHNOLOGY was estab-
lished in 1986 by the Institute of Medicine as a public-private entity
to address issues of health care technology and technology assess-
ment. The council is committed to the well-being of patients as the
fundamental purpose of technology assessment. In pursuing that
goal, the council draws on the services of experts in medicine, health
policy, science, engineering, and industry.
The Council on Health Care Technology sponsored a workshop
on International Consensus Development for Medical Technology
Assessment in London on June 7, 1989. The workshop and these
proceedings were supported in part by the National Center for Health
Services Research and Health Care Technology Assessment, grant
number HS 05526. The opinions and conclusions expressed here
are those of the authors and do not necessarily represent the views
of the National Academy of Sciences or any of its constituent parts,
the U.S. Department of Health and Human Services, or the organiza-
tions with which the authors are affiliated.
Library of Congress Catalog Card Number: 90-60936
International Standard Book Number: 0-309-04239-9
Additional copies of this report are available from:
National Academy Press
2101 Constitution Avenue, NW
Washington, DC 20418
Printed in the United States of America
S127
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Acknowledgments
Among the various authors, reactors, and other participants, rep-
resentatives of 11 countries contributed to this effort. The editors
wish to thank the authors of the consensus program profiles and the
authors and presenters of the five main workshop papers, whose
names are given with their respective contributions to this publica-
tion. The profiles were done well in advance of the workshop and
formed much of the basis for the papers presented there. The five
main papers constituted largely original work and provided the nec-
essary multinational perspective.
Important insight was provided by the reactors designated for the
main presentations, including Bj0rn Backe, Anton Casparie, lohan
Calitorp, Richard Chrzanowski, Gil Hill, Dominique Jolly, Egon
Jonsson, lard Kankaanpaa, Anna-L`iisa Kauppila, Nick Klazinga,
Jonathan Lomas, Duncan Neuhauser, and I.~.E. van Everdingen.
Bryan Jennet gave a thoughtful and stimulating welcome to the work-
shop. Itzhak Jacoby was instrumental in helping to plan the work-
shop agenda. Based on the workshop deliberations, the writing group
of 10 people from five countries drafted, reviewed, and edited mul-
tiple versions of the recommendations included here for improving
consensus development efforts.
We gratefully acknowledge the assistance of the King's Fund Centre
for hosting the workshop and wish to thank in particular Barbara
Stocking, Jackie Spiby, and Maria Said. Holly Dawkins and Evan-
. . .
111
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iv
ACKNOW~:DGMENTS
son Joseph of the Institute of Medicine staff were most helpful with
logistical arrangements and related support. Partial support for this
project was provided by grant HS 05526 from the National Center
for Health Services Research and Health Care Technology Assess-
ment.
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COUNCIL ON HEALTH CARE TECHNOLOGY
Chair
WILLIAM N. HUBBARD, JR.
Former President
The Upjohn Company
Co-Chair
JEREMIAH A. BARONDESS
Professor of Clinical Medicine
Cornell University Medical
College
HERBERT L. ABRAMS
Professor of Radiology
Stanford University School of
Medicine
RICHARD E. BEHRMAN
Managing Director
Center for the Future of Children
The David and Lucile Packard
Foundation
PAUL A. EBERT
Director
American College of Surgeons
PAUL S. ENTMACHER
Senior Adviser, Medical Policy
Metropolitan Life Insurance
Company
MELVIN A. GLASSER
Director
Health Security Action Council
BEN L. HOLMES
Vice President/General Manager
Medical Products Group
Hewlett-Packard Company
GERALD D. LAUBACH
President
Pfizer, Inc.
v
WALTER B. MAHER
Director
Federal Relations
Human Resources Office
Chrysler Motor Corporation
WAYNE R. MOON
Executive Vice President &
Operations Manager
Kaiser Foundation Health Plan,
Inc.
LAWRENCE C. MORRIS, JR.
Consultant in Health Care
Financing and
Former Senior Vice President
Health Benefits Management
Blue Cross and Blue Shield
Association
FREDERICK MOSTELLER
Roger I. Lee Professor Emeritus
Director
Technology Assessment
Program
School of Public Health
Harvard University
MARY O. MUNDINGER
Dean, School of Nursing
Columbia University
ANNE A. SCITOVSKY
Chief, Health Economics
Department
Palo Alto Medical Foundation
GAIL L. WARDEN
President and Chief Executive
Officer
Henry Ford Health Care
Corporation
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Preface
Recently, in many countries, the interests of different groups con-
cerned with health care have focused on the use of medical tech-
nologies—their safety, efficacy, and effectiveness; their cost-effec-
tiveness and cost-benefit; their impacts on quality of care; and their
social, legal, and ethical implications. The sum of these varied
interests comprises the field of health care technology assessment.
The Council on Health Care Technology was created in the United
States to promote the development and application of technology
assessment in health care and the review of health care technologies
for their appropriate use. The council was established as a public-
private enterprise at the Institute of Medicine, a component of the
National Academy of Sciences, through the Health Promotion and
Disease Prevention Amendments of l9X4 (P.L. 98-551, later amended
by P.L. 99-1171. In 1987 the U.S. Congress extended support for
the council as a public-private venture for an additional three years
(by P.L. 100-177).
The goals and objectives of the council, as stated in the report of
its first two years of operations, are "to promote the development
and application of technology assessment in medicine and to review
medical technologies for their appropriate use. The council is guided
in its efforts by the belief that the fundamental purpose of technol-
ogy assessment is to improve patient well-being and the quality of
. ~
V11
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· ~ —
V111
PREFACE
care." In pursuing these goals, the council seeks to improve the use
of medical technology by developing and evaluating the measure-
ment criteria and the methods used for assessment, to promote edu-
cation and training in assessment methods, and to provide technical
assistance in the use of data from published assessments.
The council has conducted its activities through several panels
and committees. Members of these groups reflect a broad set of
interested constituencies physicians and other health professionals,
patients and their families, payers for care, biomedical and health
services researchers, manufacturers of health-related products, man-
agers and administrators throughout the health care system, and public
policymakers.
The Methods Panel of the Council on Health Care Technology
has worked toward the improvement of the methods, techniques, and
procedures of technology assessment. The pane] objectives included
strengthening of the ability of health care institutions to acquire
primary data for the assessment of medical technology, increasing
the number of assessments of medical technology that are based
upon primary data, strengthening of the methods that provide alter-
natives to randomized controlled clinical trials, and development of
technology assessment methods, following the development of meth-
ods for health quality assessment and assurance. The Methods Panel
conducted a variety of projects in pursuit of these goals.
Through the council, the Methods Panel promoted the examina-
tion of group judgment methodologies by way of a series of work-
shops. In June of 1989 the council organized a one-day workshop
on International Consensus Development Conferences in conjunc-
tion with the annual meeting of the International Society for Tech-
nology Assessment in Health Care. The workshop allowed partici-
pants to review and consolidate findings on alternative approaches
to consensus development efforts, develop recommendations or guide-
lines for conducting these efforts, and identify research needs for
resolving methodologic questions. This report records the proceed-
ings and findings of that workshop.
William N. Hubbard, Ir., Chair
Jeremiah A. Barondess, Co-chair
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Contents
Introduction
.
Elements of the Consensus Development Process
1
Sponsorship and Role of Consensus Development Programs
within National Health Care Systems.................
Itzhak Jacoby
Topic and Scope of Consensus Development Conferences:
Criteria and Approach for Selection of Topics and
Properties for Assessment .................................
Tore Scherste'n
Documentation and Use of Evidence in the Consensus
Conference Process.......................................
Gerard Breart
Format and Conduct of Consensus Development Conferences:
A Multination Comparison.................................
Elizabeth A. McGlynn, Jacqueline Kosecoff, and
Robert H. Brook
Dissemination and Impact of Consensus Development
Statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Arnold D. Kaluzny
1X
18
23
32
69
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x
Program Profiles
Profile of a Consensus Development Program in Canada:
The Canadian Task Force on the Periodic Health
Examination . . e e e e ~ e e e e e e e e e e e e e e e e e ~ e e e e e e e e e e
Renaldo N. Battista
Profile of a Consensus Development Program in Canada:
The Canadian Research Group e e e e e e e e e e ~ e e e e e e e
Jonathan Lomas
Profile of the Consensus Development Program in Denmark:
The Danish Medical Research Council and The Danish Hospital
Institute . ........................ e e e e e e e
CONTENTS
87
93
Torben Jorgensen
Profile of the Consensus Development Program in Finland:
The Medical Research Council of The Academy of Finland
Anna-Liisa Kauppila
Profile of the Consensus Development Program in
The Netherlands: National Organization for Quality
Assurance in Hospitals (CB03 110
Niek S. RIazinga, Anton F. Casparie, and
]. ]. E. van Everdingen
Profile of the Consensus Development Program in Norway:
The Norwegian Institute for Hospital Research and
The National Research Council 118
Born Backe
Profile of the Consensus Development Program in Sweden:
The Swedish Medical Research Council and The Swedish
Planning and Rationalization Institute for the Health and
Social Services..........................................
... 102
125
Stefan Hakansson and Ingemar Eckeriand
Profile of the Consensus Development Program in the United
Kingdom: The King's Fund Forum 131
Jackie Spiby
Profile of the Consensus Development Program in the United
States: The National Institutes of Health Office of Medical
Applications of Research 137
Sharon R. Baratz
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CON7INTS
Recommendations for Strengthening Consensus
Development for Assessing Health Technologies
International Consensus Development Bibliography
List of Authors
X1
147
55
161
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