Abrams H L, Hessel S
Department of Radiology, Stanford University School of Medicine, CA 94305.
AJR Am J Roentgenol. 1987 Dec;149(6):1127-32. doi: 10.2214/ajr.149.6.1127.
From a national perspective, the central prerequisite of the proper application of medical technology is the timely determination of efficacy, cost, safety, and societal impact. This applies to both the introduction of the new methods and the retirement of older methods that may have outlived their usefulness. Within that framework, the rapid diffusion of innovative methods of great value must be balanced against the cost of premature enthusiasm for techniques with little or no incremental diagnostic or therapeutic gain. A nongovernmental Council on Health Care Technology Assessment of the Institute of Medicine-National Academy of Sciences was established by the Congress in 1986. The Council was charged to serve as an information clearing-house, a center to promote research and education, and a stimulus to establish better methods of assessment and more prompt identification of potentially important technologies. It represents virtually all of the constituencies concerned with adequate evaluation of new and existing methods. The Council confronts the critical problems of timing, bias, the quality of primary data collection, new methods of secondary data analysis, the nature of the "laboratory" in which technology assessment is best accomplished, the "exploitative" character of technology assessment research, appropriate diffusion, and ethnical issues. The appropriate use of technology in modern health care depends on the resolution of these issues.
从国家层面来看，正确应用医疗技术的核心前提是及时确定其有效性、成本、安全性及社会影响。这既适用于新方法的引入，也适用于那些可能已过时的旧方法的淘汰。在此框架内，极具价值的创新方法的快速传播必须与过早热衷于那些几乎没有或根本没有增加诊断或治疗效果的技术所带来的成本相权衡。1986年，国会设立了医学研究所 - 美国国家科学院下属的一个非政府医疗技术评估委员会。该委员会的职责是充当信息交流中心、促进研究与教育的中心，并推动建立更好的评估方法以及更迅速地识别潜在的重要技术。它几乎代表了所有关注充分评估新旧方法的相关群体。该委员会面临着诸多关键问题，包括时机、偏差、原始数据收集的质量、二次数据分析的新方法、最适合进行技术评估的“实验室”的性质、技术评估研究的“剥削性”特征、适当的传播以及伦理问题。现代医疗保健中技术的合理使用取决于这些问题的解决。
