Use of EPC Evidence Reviews: NIH Consensus Development Program (Text Version)

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!