Technology and Outcomes Assessment
February 8-9, 2007
Technology and Outcomes Assessment for Health Care Policy Reform
Three considerations make technology and outcomes assessment critical for analysis. First, technology is the main cost driver of increases in health care expenditures; second, the data on the uneven quality of care are substantial; and third, the link between use of interventions, technologies, and patient outcomes, especially in actual practice, is limited. Consequently, many reform proposals contain provisions for technology and outcomes assessment. In reality these appear to be two different types of assessments. Technology assessment evaluates the comparative and cost effectiveness of different interventions for the same condition—e.g. two anti-hypertensive medications, or mammography versus MRI imaging for breast malignancies. Outcomes assessment relates to implementation of different technologies and integration of the technologies into different processes of care. In this way it is really about how the entire delivery system affects health outcomes.
There are myriad questions of how these assessment processes operate and should operate. These can be grouped into three overarching issues. First, how should effectiveness and comparative effectiveness studies be conducted? This encompasses many sub-questions: How to ensure stakeholder involvement? How to ensure timely results? How to ensure outcomes are not just clinical but also include patients' perspectives on care delivery and quality? How to obtain outcomes information with sufficient clinical data for valid comparisons? Second, how should economics be integrated into evaluations? Third, how can the results from these technology and outcomes assessments be effectively implemented? How can results be made useful to users? What is the best way to ensure assessments are seen as legitimate grounds for coverage decisions? There is a further set of questions about how technology and outcomes assessment should be integrated into coverage and reimbursement decisions. Frequently the assessments are thought to be coverage or no coverage, but they might be used to establish different co-payment levels or requirements for participating in additional evidence collection as in Medicare's current coverage with evidence development.
There are foreign models, such as the United Kingdom's NICE, that provide some experience with technology assessment.
Since there are important differences between technology and outcomes assessment, the recommendation is to have a two-day meeting with one day on each topic and different attendees.
PDF FILES 
Working Papers:
Workshop Summary
Rapporteur Notes
Articles:
"Health Technology Assessment and Comparative Effectiveness: Recommendations for Improving Health Care Value in the United States" by Steven D. Pearson
"Outcome Assessment and Health Care Reform" by Jonathan Skinner, Amitabh Chandra, and Elliott Fisher
Commentaries:
"Technology Assessment and Setting Priorities for the Adoption on a National Level--The Israeli Experience" by Osnat Luxenburg
Technology and Outcomes Assessment: A View from Both Sides of the Atlantic
Commentary on:
Skinner J., Chandra A., and Fisher E. The Role of Outcomes Assessment in Health Care Reform
Pearson S. Health Technology Assessment and Comparative Effectiveness: Recommendations for Improving Health Care Value in the United States
By Stirling Bryan (University of Birmingham, UK) and Marthe Gold (City University of New York Medical School, New York, NY)
Commentary by Sharon Levine, on "The Role of Technology Assessment and Comparative Effectiveness Research in Increasing Health Care Value in the U.S.—Commentary and a Perspective from an Integrated Delivery System"
Commentary by Dana Goldman on "Outcome Assessment and Health Care Reform" by Jonathan Skinner, Amitabh Chandra, and Elliott Fisher
Powerpoint Presentations:
Jonathan Skinner
Steve Pearson
Stirling Bryan