By Emily P. Walker, CQ Staff
January 24, 2008 -- Congress should direct the Department of Health and Human Services (HHS) to designate a program that determines which health care services work best, an Institute of Medicine (IOM) report released Thursday recommends.
Specifically, IOM recommends an entity—a public group or one that is public–private—"with the authority, expertise, and funding necessary to set priorities for evaluating clinical services, to conduct systematic reviews of the evidence available on these priorities, and to promote the development and use of standards-based clinical practice guidelines," according to a brief on the report.
Currently, hundreds of studies, recommendations, and guidelines exist that contain a dizzying amount of information on any given medical service, drug, device, or program.
The IOM report lays out a blueprint for a private or private–public group to reach a meaningful clinical conclusion on the effectiveness of any given health care product: such as hip-replacement surgery or a blood pressure medication.
According to one of the report authors, organizations that set clinical practice guidelines would be encouraged to adhere to the group's guideline standards, and use the group's vetted data for their recommendations.
Medical societies, patient groups, government agencies, and others already do aspects of what the IOM report says a new organization should be formed to do—synthesize existing clinical studies.
But, according to one of the report's authors, there is currently no standard for synthesizing studies and producing guidelines from the results.
"There needs to be one group that says these are the standards for systematic review," said Barbara McNeill, head of the department of health care policy at Harvard School of Medicine.
The report argues that a single entity that provides "credible, unbiased, and understandable syntheses" of all available studies "could help minimize the use of questionable services and target services to the patients most likely to benefit."
Health plans also could use information provided by the group to learn how policyholders might benefit from newly available health services, the report said.
The group's findings—which would perhaps be viewable on a Web site—also could serve as a resource for medical professionals who do not have time to read dozens of studies and reviews, or who do not want to make their clinical decisions based on manufacturer-sponsored recommendations.
The group also would be responsible for setting priorities for about what clinical services need to be evaluated through systematic reviews of clinical effectiveness.
To cut down on potential bias, the IOM recommends that HHS appoint a board that represents "diverse public and private sector expertise and interests" to oversee the program.
Grace-Marie Turner, president of the Galen Institute, a free-market health care reform think-tank, said she worries that such a group might either oversimplify conclusions, or not be able to keep up with study results that change because of the availability of new data.
However, she said does see value in ensuring that the public has results from all reputable studies on a particular issue.
Karen Ignagni, president and CEO of America's Health Insurance Plans, issued a statement on the report that said, "With new treatments and technologies introduced each day, providers need a dependable and trusted source of information that provides useful guidance on treatment options available. A national entity to compare the effectiveness of new technologies will help the nation evaluate what works, what doesn't and how best to allocate resources.