Use of EPC Evidence Reviews: NIH Consensus Development Program

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Use of EPC Evidence ReviewsNIH Consensus
Development Program

• Barnett Kramer, MD, MPH
• Associate Director for Disease Prevention, NIH

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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.

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Levels of Decision Making

• Level I Would you have this done for
  yourself or for someone else in your immediate
  family?
• Influenced by ones 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

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Consensus Development Program

• Audiences
• Health Professionals
• Public
• Research Agencies

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EPC reports for OMAR

• Osteoporosis
• 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

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A Consensus Development Conference is NOT simply
an evidence report
Expert speaker testimony
Systematic evidence review
Public (audience) input
PANEL
Consensus Statement
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Selection CriteriaNIH Consensus Development
Conferencevs.State-of-the-Science Conference

• Public health importance
• Gap between knowledge and practice
• Amenable to clarification
• Strength of available evidence

• State-of-the-Science Consensus

X X
X X
X X
X
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RCTs Dbl Blind
Stronger Evidence
RCTs
Cohort Studies
Case Control Studies
Weaker Evidence
Case Series
Case Reports
Ideas Opinions
State-of-the-Science Conference
Consensus Conference
Identical Conference Process
Consensus Conference Statement Focused on
Practice Recommendations
State-of-the-Science Statement Focused on
Research Agenda
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NIH Consensus Development Process
Topic Proposal from Institute or Center
NIH Organizational Meeting
Finalize Questions Nominate Speakers Nominate
Panelists Set Agenda Set Conference Title/Date
Planning Committee (Experts, Institutes,
Agencies)
AHRQ Evidence Report
Panelists Meet Pre-Conference (Panelists are
independent, non-DHHS, general expertise, but
not doing research on the issues at hand)
Review AHRQ report
14 Months
Expert Testimony (Speakers)
Conference
Public Input (Discussion Periods)
Press Conference Draft Statement Posted on Web
(http//consensus.nih.gov)
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The Panel
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On Behalf of NIH, Thank You!