[Federal Register Volume 61, Number 247 (Monday, December 23, 1996)]
[Notices]
[Pages 67554-67556]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-32515]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Health Care Policy and Research


Nominations of Topics for Evidence-based Practice Centers (EPCs)

    The Agency for Health Care Policy and Research (AHCPR) invites 
nominations of topics for evidence reports on the prevention, 
diagnosis, treatment, and management of common diseases and clinical 
conditions and, where appropriate, the use of alternative/complementary 
therapies, and for technology assessments of specific medical 
procedures or health care technologies.
    As part of the effort to reorganize and restructure its programs, 
AHCPR is no longer facilitating the development of clinical practice 
guidelines and is expanding its program of health care technology 
assessments. AHCPR will serve as a science partner with private-sector 
and other public organizations in their efforts to improve the quality, 
effectiveness, and appropriateness of health care delivery in the 
United States. The Agency's goal is to narrow the gap between what is 
known and what is done in health care. AHCPR will support Evidence-
based Practice Centers (EPCs) to undertake scientific analyses and 
evidence syntheses of high-priority topics. The EPCs will produce 
science syntheses--evidence reports and technology assessments--that 
provide the scientific foundation for public and private organizations 
to use in developing and implementing their own practice guidelines, 
performance measures, and other tools to improve the quality of health 
care and in making decisions related to the effectiveness or 
appropriateness of specific health care technologies.
    The process that AHCPR will employ to select priority topics for 
analyses by the EPCs is described below.

Background

    Under Title IX of the Public Health Service Act, AHCPR is charged 
with enhancing the quality, appropriateness, and effectiveness of 
health care services and access to such services. AHCPR accomplishes 
these goals through scientific research and through promotion of 
improvements in clinical practice (including the prevention of diseases 
and other health conditions) and improvements in the organization, 
financing, and delivery of health care services (42 U.S.C. 299-299c-6 
and 1320b-12). In carrying out these purposes, AHCPR, among other 
activities, has in the past arranged for the development of clinical 
practice guidelines and has conducted assessments of health care 
technologies.
    Through the creation of EPCs, AHCPR will be better able to serve as 
a science partner with private-sector and other public organizations in 
addressing a greater number of health care topics and a broader range 
of clinical conditions and health problems. The EPCs will provide a 
strong scientific foundation for private and public organizations to 
use in their own efforts to improve clinical practice. The EPCs will 
conduct literature reviews and assess and synthesize scientific 
evidence to produce evidence reports and technology assessments. The 
reports and assessments will provide systems of care, provider 
societies, health plans, public and private purchasers, States, and 
others a scientific foundation for development and implementation of 
their own practice guidelines, clinical

[[Page 67555]]

pathways, review criteria, performance measures, and other tools to 
improve the quality of care in their own settings and populations. They 
may also be used to inform health care decisions, such as coverage 
policies, based on the effectiveness or appropriateness of specific 
services, procedures, or technologies.

Evidence-Based Practice Centers (EPCs)

    AHCPR will support the establishment of a group of EPCs. The EPCs 
will prepare evidence reports and technology assessments on topics for 
which there is significant demand by health care providers, insurers, 
purchasers, health-related societies, and consumer organizations. Such 
topics may include the prevention, diagnosis and/or treatment of 
particular diseases or health conditions including, where appropriate, 
the use of alternative/complementary therapies, as well as the 
appropriate use of more commonly provided services, procedures, or 
technologies. AHCPR will publish and widely disseminate to potential 
users the evidence reports and technology assessments produced by the 
EPCs.

Selection Criteria

    Selection criteria for AHCPR evidence report and technology 
assessment topics include: (1) high incidence or prevalence in the 
general population or in major subpopulations as defined by age, 
gender, or ethnicity and other populations; (2) significance for the 
needs of the Medicare and Medicaid, and other Federal health programs; 
(3) high costs associated with a condition, procedure, treatment, or 
technology, whether due to the number of people needing care, high unit 
cost of care, or high indirect costs; (4) controversy or uncertainty 
about the effectiveness or relative effectiveness of available clinical 
strategies or technologies; (5) potential to inform and improve patient 
or provider decisionmaking; (6) potential to reduce clinically 
significant variations in the prevention, diagnosis, treatment, or 
clinical management of a disease or condition, or in the use of a 
procedure or technology, or in the health outcomes achieved; (7) 
availability of scientific data to support the study or analysis of the 
topic; and (8) potential opportunities for rapid implementation. The 
topics selected will complement AHCPR's efforts to build a balanced 
portfolio of evidence reports and technology assessments.
    These criteria are consistent with the criteria in the Public 
Health Service Act; section 914 (42 U.S.C. 299b-3) for selecting 
priority topics for guideline development and section 904 (42 U.S.C. 
299a-2) for prioritizing topics for technology assessment. The process 
set out in this Notice supersedes the proposed methodology for 
establishing priorities for health care technology assessments, that 
was published in the Federal Register on April 25, 1994 (59 FR 19725).

Nomination and Selection Process

    All nominations of topics for AHCPR evidence reports and technology 
assessments should be focused on specific aspects of prevention, 
diagnosis, treatment and/or management of a particular condition, or on 
an individual procedure, treatment, or technology. Potential topics 
should be carefully defined and circumscribed, so that within 6 to 12 
months databases can be searched, the evidence reviewed, supplemental 
analyses performed, and final evidence reports or technology 
assessments produced. Topics selected will not duplicate current and 
widely available clinical practice guidelines or technology assessments 
(unless new evidence suggests the need for revisions or updates).
    Nominations should be brief (1-2 pages) and may be in the form of a 
letter. For each topic nominated, nominators should provide a rationale 
and any available supporting evidence reflecting the importance and 
clinical relevance of the topic. They should also indicate the 
potential usefulness of the evidence report or technology assessment 
within their professional practices or organizations. Information 
should include:
     A clearly defined topic, with specific questions to be 
answered that will establish the focus and boundaries of the report.
     Indication of the availability of data for study and if 
available, any information on the incidence, prevalence and/or severity 
of the particular disease or health condition including, if relevant, 
its significance for the Medicare and Medicaid populations; or the 
frequency of use and cost of the procedure, treatment, or technology; 
an indication of how the evidence report or assessment might be used 
within the nominator's professional or organizational setting; and any 
known currently available technology assessments, practice guidelines, 
disease management protocols, or other tools or standards pertaining to 
the topic and their deficiencies if any.
     References to significant differences in practice patterns 
and/or results, the availability of alternative therapies, and any 
known controversies in these areas.
    Nominators of topics that are selected may have the opportunity to 
serve as resources to EPCs as they develop evidence reports and 
technology assessments. Nominators may also be requested to serve as 
peer reviewers of draft evidence reports and technology assessments.
    AHCPR will review topic nominations and supporting information and 
determine final topics, seeking additional information as appropriate. 
Final topics will be assigned to specific EPCs.

Materials Submission and Deadline

    To be considered for the first group of evidence reports and 
technology assessments, topic nominations should be submitted by 
February 21, 1997 to: Douglas B. Kamerow, M.D., M.P.H., Director, 
Office of the Forum for Quality and Effectiveness in Health Care, 
Agency for Health Care Policy and Research, 6000 Executive Boulevard, 
Willco Building, Suite 310, Rockville, Maryland 20852.
    Nominations may also be made electronically as an ASCII file, 
either as an attachment or incorporated into the body of the message, 
to the following e-mail address: [email protected].
    After February 21, 1997, nominations will be accepted on an ongoing 
basis by mail or electronically at the above addresses for topics for 
subsequent evidence reports and technology assessments.
    All responses will be available for public inspection at the Office 
of the Forum for Quality and Effectiveness in Health Care, telephone 
(301) 594-4015, weekdays between 8:30 a.m. and 5 p.m. AHCPR will not 
reply to individual responses, but will consider all nominations in 
selecting priority topics. Topics selected will be announced from time 
to time in the Federal Register and in AHCPR press releases.

Request for Evidence-Based Practice Center Solicitation

    To receive a copy of the contract solicitation for the EPCs, mail 
or telefax: requestor's name, affiliation (business or organization); 
address (including zip code); and telephone and telefax numbers to: 
Agency for Health Care Policy and Research, Office of Management, 
Contracts Management Staff, Attn.: Al Deal, Suite 601, 2101 East 
Jefferson Street, Rockville, MD 20852, telefax (301) 443-7523. The 
solicitation is also available as an FTP file through AHCPR's Web site: 
www.ahcpr.gov/news/

[[Page 67556]]

For Additional Information

    Additional information about topic nominations can be obtained by 
contacting: Margaret Coopey, Health Policy Analyst, Office of the Forum 
for Quality and Effectiveness in Health Care, Agency for Health Care 
Policy and Research, 6000 Executive Boulevard, Willco Building, Suite 
310, Rockville, Maryland 20852, telephone (301) 594-4015. E-mail 
address [email protected].

    Dated: December 18, 1996.
Clifton R. Gaus,
Administrator.
[FR Doc. 96-32515 Filed 12-20-96; 8:45 am]
BILLING CODE 4160-90-M