Comparative-Effectiveness Research (CER)
Submitted by Dr. JG Kaplan on Tue, 2009-06-30 19:55
After obtaining input from the public and professional organizations, as required by ARRA, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization selected 100 topics. *
* They reduced a field of 1268 CER topics to 82 and then added 18.
The American Recovery and Reinvestment Act (ARRA) supports comparative-effectiveness research (CER). Also referred to as "Patient-Centered Outcomes Research Act of 2009," CER makes information available to help "cliniciansand patients choose the options that best fit the individualpatient's needs and preferences."
DEFINTION OF CER
The "conduct and synthesis of research comparingthe benefits and harms of various interventions and strategiesfor preventing, diagnosing, treating, and monitoring healthconditions in real-world settings. The purpose of this researchis to improve health outcomes by developing and disseminatingevidence-based information to patients, clinicians, and otherdecision makers about which interventions are most effectivefor which patients under specific circumstances."
Per the Federal Coordinating Council for ComparativeEffectiveness Research, which is established by the Office ofthe Secretary in the Department of Health and Human Services(DHHS)
CER, broadly, is concerned with the methodology of information technology (I.T.), data infrastructure, the translation of data into information and its promulgation (although they would undoubtedly prefer the word, "dissemination," it being less aggressive).
Conway PH, Clancy C. "Comparative-Effectiveness Research — Implications of the Federal Coordinating Council's Report" Published at www.nejm.org June 30, 2009 (10.1056/NEJMp0905631)
The IOM committee also recommended "supporting CER related to patients' decision making, unhealthy behaviors such as smoking, and determining the most effective dissemination methods to ensure translation of CER results into best practices."
Key Priority Areas of Interest
The graph shows 100 primary and 193 secondary research topics by topic with "Health Care Delivery System" being the most prevalent. After that, nearly 1/3 wasracial and ethnic disparities, 1/5 was patients'functional limitations and disabilities. Thereafter, in terms of prevalence, were: cardiovascular disease that ranked second as a primary research area [1], geriatrics, psychiatric disorders that ranked third as an area for primary research [2], neurologic disorders [3], pediatrics and cancer [4].
[1] Cardiovascular and peripheral vascular (CV-PVD) diseases were the leading causes of death in the U.S. in 2006. Note: one might consider in this context that heart disease is a co-morbidity where the primary disease or condition is diabetes or obesity, respectively; and both of these are, unfortunately, increasingly more prevalent.
[2] Includes mental health care—venues and locations, provider training, pharmacologic treatments of or for depression and/or suicide consequent to mental disorders.
[3] Incorporates diagnostic imaging and interventions for headaches, multiple sclerosis, epilepsy and dementias including Alzheimer's disease.
[4] Cancer is second to CV-PVD in U.S. deaths and "one of the most costly diseases to treat. [It] is the focus ofsix recommended primary CER topics, including screening technologiesfor colorectal and breast cancers and the [appropriate] use of imaging technologiesfor diagnosing, staging, and monitoring all cancers.
Iglehart, John K. "Prioritizing Comparative-Effectiveness Research -- IOM Recommendations." N Engl J Med .June 30, 2009; pub. Online: 0: NEJMp0904133
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