[Federal Register Volume 62, Number 229 (Friday, November 28, 1997)]
[Notices]
[Pages 63345-63346]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-31205]


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

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 a 
second round of 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. AHCPR's first request 
for topic nominations was published in the Federal Register on December 
23, 1996 (61 FR 67554-67556).
    AHCPR serves 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, and to speed the translation of evidence-based research 
findings into improved clinical care. AHCPR supports Evidence-based 
Practice Centers (EPCs) to undertake scientific analyses and evidence 
syntheses on high-priority topics. The EPCs 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 
make decisions related to the effectiveness or appropriateness of 
specific health care technologies.
    As a result of nominations received in response to AHCPR's December 
1996 Federal Register notice, EPCs are developing an evidence report or 
a technology assessment on the following topics: (1) Testosterone 
suppression treatment of prostatic cancer; (2) evaluation of cervical 
cytology; (3) diagnosis and treatment of dysphagia/swallowing problems 
in the elderly; (4) evaluation and treatment of new onset of atrial 
fibrillation in the elderly; (5) diagnosis of sleep apnea; (6) 
treatment of attention deficit and hyperactivity disorder; (7) 
diagnosis and treatment of acute sinusitis; (8) rehabilitation of 
persons with traumatic brain injury; (9) prevention and management of 
urinary complications in paralyzed persons; (10) pharmacotherapy for 
alcohol dependence; (11) management of stable angina; and (12) 
treatment of depression with new drugs.
    The process that AHCPR employs to select 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

[[Page 63346]]

the development of clinical practice guidelines and has conducted 
assessments of health care technologies.
    Through the creation of EPCs, AHCPR is 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 provide a strong 
scientific foundation for private and public organizations to use in 
their own efforts to improve clinical practice. The EPCs 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 with a 
scientific foundation for development and implementation of their own 
practice guidelines, clinical 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 or reimbursement policy, based on the 
effectiveness or appropriateness of specific services, procedures, or 
technologies.

Evidence-based Practice Centers (EPCs)

    The EPCs 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 widely disseminate 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 subpopulations, including racial and ethnic 
minorities and other populations; (2) significance for the needs of the 
Medicare, 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 also will complement AHCPR's efforts to build a 
balanced portfolio of evidence reports and technology assessments.

Nomination and Selection Process

    Nominations of topics for AHCPR evidence reports and technology 
assessments should focus 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 is available that 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 and should 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.
      The availability of data to 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; alternative therapies and controversies.
    Nominators of selected topics 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 assessments.
    The AHCPR will review topic nominations and supporting information 
and determine final topics, seeking additional information as 
appropriate.

Materials Submission and Deadline

    To be considered for the next group of evidence reports and 
technology assessments, topic nominations should be submitted by 
January 30, 1998 to: Douglas B. Kamerow, M.D., M.P.H., Director, Center 
for Practice and Technology Assessment, Agency for Health Care Policy 
and Research, 6000 Executive Boulevard, Willco Building, Suite 310, 
Rockville, Maryland 20852.
    Nominations also will be accepted on an ongoing basis at the above 
address for topics for subsequent evidence reports and technology 
assessments.
    All responses will be available for public inspection at the Center 
for Practice and Technology Assessment, 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 
topics. Topics selected will be announced, from time to time, in the 
Federal Register and AHCPR press releases.

For Additional Information

    Additional information about topic nominations can be obtained by 
contacting: Jacqueline Besteman, EPC Project Officer, Center for 
Practice and Technology Assessment, 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: November 21, 1997.
John M. Eisenberg,
Administrator.
[FR Doc. 97-31205 Filed 11-26-97; 8:45 am]
BILLING CODE 4160-90-M