Slide Presentation from the AHRQ 2008 Annual Conference
On September 10, 2008, Barnett Kramer, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (410 KB).
Slide 1
Use of EPC Evidence Reviews: NIH Consensus Development Program
- Barnett Kramer, MD, MPH
Associate Director for Disease Prevention
Consensus Development Program
- National Institutes of Health (NIH)
Slide 2
Consensus Development Program
- Goal:
- Produce an unbiased, evidence-based assessment of a complex/controversial medical issue that will advance understanding for health professionals and the public.
Slide 3
Levels of Decision Making
- Level I: "Would you have this done for yourself or for someone else in your immediate family?"
- Influenced by one's personal experience with the disease and capacity to deal with risk.
- Affects few people.
- Level II: "What would I recommend to my patient/client?"
- Physician making a recommendation for his/her patients. Influenced by prior experience, but the scientific evidence may play a greater role.
- Affects possibly hundreds of people.
- Level III: "What would I recommend to the nation, the world?"
- Across-the-board recommendations for a population.
- Must be based on rigorous assessment of the scientific evidence.
- Affects hundreds of thousands, even millions of people.
- Slide courtesy of Leon Gordis, M.D., Johns Hopkins University.
Slide 4
Consensus Development Program
- Audiences:
- Health Professionals.
- Public.
- Research Agencies.
Slide 5
Evidence-based Practice Centers (EPCs) reports for Office of Medical Application and Research (OMAR)
- Osteoporosis.
- Endoscopic Retrograde Cholangiopancreatography (ERCP).
- Management of Hepatitis C.
- Management of Cancer Symptoms.
- Management of Clinically Inapparent Adrenal Mass.
- Total Knee Replacement.
- Youth Violence.
- Improving End-of-life Care.
- Management of Menopausal Symptoms.
- Cesarean Delivery on Maternal Request.
- Multivitamin/Mineral Supplements and Chronic Disease.
- Tobacco Prevention, Cessation, and Control.
- And More...
Slide 6
A Consensus Development Conference is NOT simply an evidence report...
- Slide shows Expert speaker testimony, Systematic evidence review, and Public (audience) input all influencing the Panel, which then issues a consensus statement.
Slide 7
Selection Criteria: NIH Consensus Development Conference vs. State-of-the-Science Conference
- Table compares consensus development conference to state-of-the-science conference.
- Public health importance
State-of-the-Science: Yes—Consensus Yes.
- Gap between knowledge and practice
State-of-the-Science: Yes—Consensus Yes.
- Amenable to clarification
State-of-the-Science: Yes—Consensus Yes.
- Strength of available evidence
State-of-the-Science: [blank]—Consensus Yes.
Slide 8
Identical Conference Process
- Diagram shows pyramid with similar tiers, top to bottom:
- Randomized controlled trials (RCTs) Dbl Blind.
- RCTs.
- Cohort Studies.
- Case Control Studies.
- Case Series.
- Case Reports.
- Ideas and Opinions.
- Difference between results of an identical conference process:
- The top three tiers constitute stronger evidence upon which a consensus conference would base a Consensus Conference Statement Focused on Practice Recommendations.
- The bottom four tiers constitute weaker evidence leading to a State-of-the-Science Statement Focused on Research Agenda.
Slide 9
NIH Consensus Development Process
- Flow chart shows a 14-month process in which a Topic Proposal from Institute or Center leads to an NIH Organizational Meeting, after which a Planning Committee of experts, institutes and agencies would:
- Produce an AHRQ Evidence Report.
- Finalize Questions.
- Nominate Speakers.
- Nominate Panelists.
- Set Agenda.
- Set Conference Title/Date.
- Panelists Meet Pre-Conference to review AHRQ reports.
- (Panelists are independent, non-Department of Health and Human Services (HHS), general expertise, but not doing research on the issues at hand).
- The Panelists, Public Input (discussion periods), and Expert Testimony (Speakers) all have a role in producing a press conference and draft statement posted on Web (http://consensus.nih.gov).
Slide 10
The Panel
- Photo shows formal portrait of members of the U.S. Supreme Court.
- On Behalf of NIH, Thank You!
Current as of January 2009
Internet Citation:
Use of EPC Evidence Reviews: NIH Consensus Development Program. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/091008slides/Kramer.htm