Initial National Priorities for Comparative Effectiveness Research (2009) / Chapter Skim
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4 The Criteria and Process for Setting Priorities
4 The Criteria and Process for Setting Priorities
Pages 77-96
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From page 77... ...
Prioritization of CER topics should be a sustained and continuous process that requires the prioritizing body to make regular reports to the Secretary of Health and Human Services, in volves the public in a transparent process, and is informed by robust topic briefs and background information. Introduction The previous chapter described the committee's method of obtaining the nominated topics from stakeholders and the public, while this chapter describes the prioritization criteria and process the committee used in its 77
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From page 78... ...
The committee relied on these past IOM and external reports to develop the criteria it used in the voting process that established the final priority CER topics. The committee's voting process that was used to narrow the list of nominated topics to a manageable, high priority portfolio is also described in detail.
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. The distribution of the nominated research topics according to the portfolio's characteristics was provided to the committee throughout each step in the voting process.
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Criteria Chosen for priority setting In addition to the portfolio criteria intended to assess the balance of all the priority CER topics, the committee also concluded that criteria were needed to evaluate the individual nominated research topics. The committee reviewed the criteria used for priority setting by other projects and the two IOM reports discussed below, but it developed its own set of criteria that applied specifically to setting priorities for CER.
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From this information, committee members might determine that a particular condition targeted in a proposed research topic is widespread and so it may be of importance to study; however, they had little or no information on other aspects of the topic such as whether particular procedures, clinical decisions, or delivery models were also prevalent or appropriate for CER. The specific priority topic-level criteria considered by the committee were intended to help assess the particular questions identified in the nominated research topics, not just the conditions and diseases.
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Does H the proposed study explicitly include them? o ave previous studies ignored patients from special popula H tions?
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For the second round of voting, the committee was provided several proxy indicators for knowledge and information gaps, including the most recent systematic reviews as well as the funding source and number of recent and ongoing clinical trials. The AHRQ Effective Health Care Program's issue briefs and the National Institutes of Health's registry of privately and publicly supported clinical trials in the United States and abroad supplied data on perceived knowledge gaps remaining to be addressed.
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Consequently, although committee members were instructed to take into account quantitative data such as prevalence, morbidity, and cost where such data were available, the voting process had subjective elements in terms of how each member selected their top priorities. Lessons From previous Priority-setting processes IOM Reports For this project, the most relevant IOM reports concerning priority setting, Priority Areas for National Action (IOM, 2003)
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The criteria reflected potential impact (disease burden variables) , improvability (the likelihood the priority would address one of the six quality aims in the 2001 Quality Chasm report)
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. External Priority-Setting Initiatives In addition to the two IOM reports, the CER committee reviewed the following external priority-setting initiatives to select the condition-level criteria and priority topic-level criteria: AHRQ's Effective Health Care Program, which identified topics for comparative effectiveness systematic reviews (Whitlock et al., 2009)
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As described above, the committee incorporated the appropriateness of the topic for CER and information gaps and duplication into the priority topic-level criteria. The Committee on Comparative Effectiveness Research Prioritization also considered the methodology used by the other priority-setting groups to arrive at its final priority CER topics including the following: • The creation of a specific taskforce or committee to oversee and ultimately vote on the priority questions • invitation for stakeholders to submit comments and priority An agendas via written or oral testimony to committee members • The establishment of explicit priority criteria (and gathering of data sources/information relevant to criteria)
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expectancy, quality of life: looked at global assessments, healthy days, and years of healthy life • Goal 2: Eliminate Health Disparities -- In terms of gender, race and ethnicity, income and education, disability, geographic location, and sexual orientation • Leading Health Indicators considered when choosing focus areas -- physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, access to health care National Priorities and NPP/NQF • Eliminating harm Goals: Aligning Our • Eradicating disparities Efforts to Transform • Reducing disease burden America's Healthcare • Removing waste Improving the Use of WHO • Problems associated with a high Research Evidence in Advisory Committee burden of illness -- in low- and Guideline Development: on Health Research middle-income countries, or new 2 Priority Setting and emerging diseases • existing guidelines or No recommendations of good quality • Feasibility of developing recommendations -- that will improve health outcomes, reduce inequities or reduce unnecessary costs if they are implemented • Implementation is feasible -- will not exhaustively use available resources, and barriers to change are not likely to be so high they cannot be overcome • Interventions that will likely require systems changes • Interventions where there might be a conflict in choices between individual and societal perspectives
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. Similarly, the Cochrane Collaboration first chose a list of eight broad priority topics and then formulated a longer list of more specific review priorities (Doyle et al., 2005)
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Each group voted on the nominated research topics categorized into several of the 32 unique research areas, with each group voting on approximately 20 percent of the total nominated research topics, and each committee member voting independently. This design was intended to ensure that the leading nominated research topics from each of the 32 research areas were likely to be retained in the next round of voting, thus preserving the balance of the portfolio.
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In-depth discussion and review, consolidation of list to 129 topics, discussion of overall portfolio considerations, and nomination of 26 new topics to fill gaps in research areas resulting in Round 3 Voting = 155 Nominated Topics Committee voted April 19-20, 2009 Round 3 Results = Final 100 Priority Topics FIGURE 4-1 Voting process and selection of priority topics. Figure 4-1 R01511 vector, editable
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A total of 26 topics were nominated by the committee. These topics were incorporated into the 129 remaining submitted topics without distinguishing them, providing a total of 155 unique nominated research topics for consideration in the third round of voting.
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While the committee has set forth criteria here, these criteria should be revisited to ensure that they reflect the public's goals and values. Recommendation 3: Consideration of CER topics requires the devel opment of robust, consistent topic briefs providing background infor mation, current practice, nd research status of the condition and its a interventions.
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Thus, the prioritization process should produce regular reports evaluating its portfolio of potential and selected topics for CER against a variety of criteria, including type of service domain, clinical domain, population characteristics, and other policy priorities such as addressing vulnerable populations and health disparities. A rolling evaluation of the selection and prioritization processes, as well as the return on investment of prior CER research by application throughout the health system should be incorporated in the prioritization process to ensure quality improvement.
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2009. Identi fying, selecting, and refining topics for comparative effectiveness systematic reviews: AHRQ and the effective health care program.
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