1. Knowing what works in Health Care: A roadmap for the nation IOM Committee on Reviewing Evidence to Identify Highly Effective Clinical Services January 2008
25. Won’t the hybrid model simply perpetuate the chaotic system we have now?
26. Won’t the hybrid model simply perpetuate the chaotic system we have now? Not if all guideline producers adhere to The Program’s standards for process and language for rating the strength of the evidence and recommendations.
27. Tie their credibility to adherence to standards of good practice How to motivate guideline developers to adhere??
31. Getting nominations Source: IOM report “What works….”, 2008 anyone NHS NICE Anyone CMS website MCAC Anyone Varies Cochrane BCBSA people BCBSA people BCBSA Anyone Federal Register + stakeholders AHRQ & USPSTF Who can nominate? Solicitation Organ-ization
32. Topic nominations received by AHRQ (2005 and 2006) Source: IOM report “What works….”, 2008 47 Total 8 Other 16 Professional Societies 3 Health Plans 20 Federal Agencies Number Source
33. AHRQ: Categories of Topics Nominated Source: IOM report “What works….”, 2008 5 Other 8 QI and patient safety 6 Organization and Finance 1 Rehabilitation 36 Treatment 13 Diagnosis 7 Prevention Number Category
34. Priority-setting Criteria Source: IOM report “What works….”, 2008 X X Variation X X x X New Evidence X X x X Controversy X X X x X Impact X X X X Burden X X Cost USPSTF NICE OMAR BC-BSA AHRQ
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42. W = the weight for a criterion S = the score for the criterion Source: IOM Committee on Priority Setting, 1992 Priority Score = Σ W n x lnS n
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44. Staff Calculate priority score and rank order Model Assign a score to each criterion Staff + panel Obtain data for each criterion Panel Winnow the list Staff Solicit nominations of candidate technologies Panel Choose criteria and assign weights Priority Score = Σ W n x lnS n
45. 0 1 0.69 2.0 1.0 Δ ELS 1.04 2 2.08 4.0 1.5 Δ cost 2.62 3.7 2.33 3.2 2.0 Δ outco -2.13 0.17 -1.23 0.36 1.2 Var 11.24 1,800 13.66 9000 1.5 Cost 1.19 1.7 3.28 4.3 2.3 Burden 7.37 100 5.44 30 1.6 Prev W*lnS Score(S n ) W*lnS Score (S n ) W n =cardiac condition = acute surgery
46. Priority Score = Σ W n x lnS n 0 1 0.69 2.0 1.0 Δ ELS 1.04 2 2.08 4.0 1.5 Δ cost 2.62 3.7 2.33 3.2 2.0 Δ outco -2.13 0.17 -1.23 0.36 1.2 Var 11.24 1,800 13.66 9000 1.5 Cost 1.19 1.7 3.28 4.3 2.25 Burden 7.37 100 5.44 30 1.6 Prev W*lnS Score(S n ) W*lnS Score (S n ) W n =cardiac condition = acute surgery =26.25 =21.34
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