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National priorities for the assessment of clinical by Maria Elena Lara; Clifford Goodman et al.

By Maria Elena Lara; Clifford Goodman et al.

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Phelps and Parente (1989) estimate that an annual welfare loss of $280 million is associated with variations in medical practice related to medical back problems. Advance Medical Knowledge Knowledge about the biologic causes of low back pain is incomplete. Diagnostic workups often fail to pinpoint a specific anatomic cause, leading to uncertainty about the best approaches to treatment (Frymoyer, 1988). , 1979; Svensson and Andersson, 1982). This percentage of time lost from work is higher than that for any other class of health problem (Institute of Medicine, 1987b).

The priority-setting group decided to move forward with a two-round modified Delphi process to choose a first set of priorities for further study from a larger list of potential topics. The two-round component of this process was used to generate a broad, initial list of potential topics. Candidate topics listed in Appendix A were added to the list in two iterations, based on the background information provided by diverse organizations and the expertise of the members of the group. By means of a modified Delphi homework exercise, the prioritysetting group chose from this initial list a narrower field of potential topics to be considered during a later meeting of the group.

Thus, a technology approach may better represent the assessment needs of some organizations, such as payers or institutional providers of care, faced with decisions about the cost and reimbursement of specific new technologies. 3 See footnote 6 in chapter 1. The definitions for medical technologies, originated by the congressional Office of Technology Assessment (1978), were expanded by the Institute of Medicine Committee on Assessing Medical Technologies (Institute of Medicine, 1985a). In this report the terms are used as defined in the Glossary.

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