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AMA offers technology assessment program.

AMA Offers Technology Assessment Program

This issue of Physician Executive inaugurates a new column designed to provide information and insights regarding current issues in medical technology. The introductory offering in the column describes the Diagnostic and Therapeutic Technology Assessment (DATTA) program, the foundation of the American Medical Association's major activities in health care technology.

The AMA's Diagnostic and Therapeutic Technology Assessment (DATTA) program has two principal objectives. First, it seeks to provide accurate, balanced, and timely information on health care technologies to enhance appropriate utilization by practicing physicians. Second, it seeks to communicate the opinions and concerns of the practicing medical community to those formulating public policy in health care. DATTA evaluates the safety and effectiveness of drugs, devices, procedures, and technologies used in the practice of medicine. The technologies may be preventive, rehabilitative, diagnostic, or therapeutic. DATTA has concentrated mainly on the latter two areas. Additionally, the technologies may be emerging, new, in widespread use, or potentially obsolete. DATTA relies on a qualitative analytical approach that integrates expert clinical judgment with findings available in the biomedical literature. Questions for DATTA may be raised by any responsible party. Physicians, physician organizations, third-party payers, and manufacturers have all identified issues for evaluation. A significant proportion of the issues addressed by DATA have been raised by third-party payers. The qualitative analytical approach used by DATTA involves the selection of experts to evaluate specific technologies. The experts are selected from a DATTA consultant panel of 1,700 physicians who span the broad spectrum of medical specialties. DATTA questions are mailed to selected panelists, who are asked to rate the technology as being established, promising, investigational, doubtful, or unacceptable. Panelists also are requested to comment on their experience with the technology, on their knowledge of the results of controlled clinical trials, on the benefits and risks of the technology for specific subpopulations, and, if relevant, on cost considerations. Responses are collected and tabulated by DATTA staff. The ratings and other information from the panelists are then integrated by a staff physician with a synthesis of pertinent information obtained from a review of the biomedical literature. The ratings of the DATTA panel are presented explicitly at the beginning of each evaluation, along with a synopsis of the results and the underlying rationale. DATTA evaluations are submitted for publication to the Journal of the American Medical Association (JAMA). The requisite peer review by JAMA reviewers constitutes another step in a system of checks and balances regarding the accuracy and balance of DATTA evaluations. DATTA evaluations are considered complete only after consideration of the comments of JAMA reviewers. Publication in JAMA represents the primary means of communicating DATTA evaluations to practicing physicians nationwide. The demand for sound information has increased substantially as corporate America has become more involved in decisions regarding the health care for which it pays. Third-party payers, third-party administrators, health maintenance organizations (HMOs), hospitals, benefits consultants, and now self-insurers are basing explicit policy decisions on available scientific findings and expert clinical judgment. In response to this demand for authoritative evaluative information, the DATTA Subscription Service was established. The service provides new DATTA evaluations (10 per year), all previous evaluations, and a newsletter to subscribers.

DATTA Abstracts

Percutaneous Lumbar Diskectomy for Herniated Disks

Q. In patients who have not responded to

conservative therapy, is percutaneous

lumber diskectomy: 1. A safe procedure? 2. An effective procedure for the

treatment of protruding lumbar disk wherein

the nuclear bulge is contained by the

annulus? 3. An effective procedure for treatment

of a protruding lumbar disk wherein

nuclear material is outside the

annulus but still contiguous with the

nucleus--i.e., without any free

sequestered fragment? A. Percutaneous diskectomy, particularly

the automated procedure using Onik's

nucleotome, is a promising treatment

for herniated lumbar disks wherein

the nuclear bulge is contained by the

annulus. Further study is needed to

establish the safety and effectiveness

of this procedure for this indication.

When a herniated lumbar disk has

nuclear material outside the annulus

but still contiguous with the nucleus,

the majority of DATTA panelists

believe either that the risk/benefit ratio

was unfavorable or that evidence was

insufficient for a definitive decision

regarding the application of

percutaneous diskectomy.

Gastric Restrictive Surgery

Q. Are gastric bypass surgery with a

Rouxen-Y gastrojejunostomy and

verticalbanded gastroplasty safe and effective

adjunctive therapies to diet, exercise,

and behavior modification programs

in the treatment of resistant cases of

morbid obesity? A. The panelists were closely divided on

the safety and effectiveness of these

two procedures. There was no

consensus on the established and

investigational categories in either question;

a minority of the panelists thought the

safety and effectiveness of these two

procedures were either indeterminant

or unacceptable. Appropriate patient

selection appears to be a critical

determinant of success in both

procedures. Several panelists stated that

controlled trials with long-term

follow-up are needed to determine both

the safety and the effectiveness of the

procedures.

Noninvasive Electrical Stimulation for Nonunited Bone Fracture

Q. Is noninvasive electrical stimulation a

safe and effective adjunctive therapy

for stable nonunions that measure less

than half of the diameter of the bone

at the level of the nonunion of the

bone? A. A majority of the panelists agreed that

the safety of noninvasive electrical

stimulation for the treatment of

nonunions has been established. However,

the panelists were divided over the

effectiveness of electrical stimulation.

The major problem cited by the

panelists was the lack of controlled clinical

trials. Four panelists stated that

well-controlled trials were needed, three

panelists thought double-blind

studies were needed, and one panelist

commented that a better prospective

study was needed to establish the

effectiveness of this treatment. DATTA evaluations presently under way include reassessment of transrectal ultrasound in prostate cancer and prophylactic treatment for opportunistic infections in HIV-positive patients.

William T. McGivney, PhD, is Director, Division of Health Care Technology, American Medical Association, Chicago, III.
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Article Details
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Title Annotation:American Medical Association
Author:McGivney, William T.
Publication:Physician Executive
Article Type:column
Date:Nov 1, 1989
Words:973
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