National Priorities for the Assessment of Clinical Conditions and Medical Technologies Report of a Pilot Study (1990) / Chapter Skim
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The process for setting assessment priorities demonstrated in this pilot study and Be Initial set of 20 priority assessment areas selected are in response to this expanded charge. The council and its prionty-setting group opted for a two-stage strategy to address its charge to set priorities for health care technology assessment.
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Although much of the evaluation activity conducted to date has been canned out in expenmental or other more-or-less contmBed conditions, new attention is being given to '6 whet works" in genes medical practice, that is, to assessing We effectiveness of medical care delivered in eve~yday practice to improve the health outcome of patients. Research into effectiveness and patient outcomes has been prompted, in part, by rising expenditures for health care, now at about 11 percent of the yearly gross national product.
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· . prlontles encompass: explicit and welB-accepted criteria for pnor~ty-seuing mat are applicable at the national level, a conceptual framework that accommodates bow clinical conditions and medical technologies as assessment pnonties, and · an accountable process for pnority-sefflng Hat involves a broad range of assessment interests.
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They include He potential for an assessment to: · improve individual patient outcome, · affect a large patient population, · reduce unit or aggregate cost, and · reduce unexplained variations in medical practice. The secondary criteria account for over factors Hat should be taken into account in pnonty-setting decisions, but that may be more difficult to quantify because of their more genera or subjective nature.
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. The priority assessment areas listed below include 14 clinical conditions and 6 technologies: Clinical Conditions: Breast cancer Cataracts Chronic obstructive pulmonary disease Coronary artery disease Gallbladder disease Gastrointestinal bleeding Human unmunodeficiency vines infection loins disease & injury Low back pain Osteoporosis Pregnancy Prostatism Psychiatric disorders Substance abuse Technologies: Diagnostic imaging technologies Diagnostic laboratory testing Ery~poietin Lrnplantable devices Intensive care units Organ transplantation & replacement In identifying these priorities He group considered altemative medical technologies that may be used for each of the priority clinical conditions and He multiple cI~n~cal indications for the priority technologies.
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Caning attention to such shortcomings may influence the aBocation of funds to develop resources for overcoming these problems. ACCOMMODATING CLINICAL CONDITIONS AND TECHNOLOGIES A continuing process for setting national assessment priorities must accommodate the different manners and contexts in which questions about evaluating medical practice anse.
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The specific questions about these general assessment areas need to be fonnulated, the data bases and methodologies necessary to conduct these studies need to be identified or developed, the necessary manpower and financial resources need to be allocated, and the findings of these evaluations need to be widely disseminated to the health care community. Consistent win one of the roles of the Institute of Medicine, the council seeks to convene assessment organizations to encourage them to undertake high-pnonty assessments and engage them In this process.
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