In 1988 the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services proposed an Effectiveness Initiative to bring the resources of Medicare to bear on the question of what works in the practice of medicine. During this time, HCFA consulted widely with many individuals and organizations in medicine, health care financing, and health services and policy research for guidance on this new program initiative. In August 1988 HCFA requested the Institute of Medicine, National Academy of Sciences, to recommend clinical conditions that should receive priority attention initially. This emphasis on the clinical condition reflected a decision to focus on this unit of analysis rather than specific procedures or technologies. To accomplish this task, the Institute appointed a committee according to National Academy of Sciences procedures (following a collaborative consultation between the Institute and HCFA) and convened a one-day workshop on October 27, 1988, preceded by an opening session on the evening of October 26. The committee, chaired by Kenneth I. Shine, M.D., Dean of the UCLA School of Medicine, included the physicians named in the accompanying roster. This report conveys the committee's findings and recommendations pursuant to workshop deliberations.

Contents

• INSTITUTE OF MEDICINE: Division of Health Care Services
• INSTITUTE OF MEDICINE
• Introduction
  • COMMITTEE CHARGE
  • PURPOSES AND ELEMENTS OF THE EFFECTIVENESS INITIATIVE
• The Workshop
  • BACKGROUND AND CONDUCT
  • PREMISES OF THE CLINICAL WORKSHOP
• Critical Factors in the Discussion of Clinical Conditions
• Recommended Clinical Conditions for the Effectiveness Initiative
  • FIRST TIER
  • SECOND TIER

This workshop was supported by the Health Care Financing Administration, U.S. Department of Health and Human Services, under Purchase Order Nos. HCFA–89-0012 and HCFA–89-0015.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

The report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.