Building on my post last week about comparative effectiveness research (CER), there were three pieces in last week’s New England Journal of Medicine on CER. I thought that Jerry Avorn, MD, delivered the best summary statement on the debate that erupted in advance of ARRA funding of CER: “Given the quality and cost crises we face, preserving ignorance would have been a poor strategy for improving the effectiveness, safety, and affordability of health care.”

In “The Neglected Purpose of Comparative-Effectiveness Research,” Aanand Naik, MD, and Laura Petersen, MD, MPH, raise some important issues:

“Surprisingly little attention has been paid to what we believe is the most critical question facing CER: Will its results significantly improve the quality and safety of the health care received by the average patient? Policymakers and research funders, such as the National Institutes of Health, often assume that the final steps in the translation of clinical research — the decision to act on new medical evidence and its implementation in routine care — are seamless and automatic, whereas we know that changing the behavior of physicians and patients is difficult. Though we agree that the need for CER is clear, many of the assumptions regarding the most important aspect of such research — the ultimate implementation of its findings into health care — have little empirical support.”

Or, perhaps more directly to the point:

 ”These efforts suggest that some researchers and policymakers guiding the three tiers of evidence translation have come to understand that a shift is needed from the ’science of recommendation to a science of implementation.’ … We also need evidence-based methods for discovering and describing how the findings of clinical trials and CER can be efficiently implemented and incorporated into routine practice.”

Naik and Petersen are absolutely right. Building these insights into what I reported on last week, here are five guidelines for the evolution of CER:

1. CER is critically important to filling information gaps for clinicians and patients.
2. If we want to CER to truly help patients, they need to be at the table in CER design to identify priorities and ask research questions.
3. CER findings need to be broadly disseminated, including to consumers, which means that they need to be translated into a way that makes CER findings meaningful to consumers.
4. CER dissemination is not enough to ensure the consumer engagement in care that is so critical to better, more efficient health care.
5. We need to work just as hard (through both innovation design and scientific research) to develop creative strategies — like information therapy (Ix) — to ensure that CER findings are well integrated into the care delivery process in a way that supports shared decision making (SDM) and participatory medicine.

Any suggested additions, amendments, or comments?

This entry was posted on Wednesday, May 13th, 2009 at 9:35 am and is filed under Comparative Effectiveness Research, Consumer empowerment, Inside the Beltway, Participatory Medicine, Patient-Clinician Relationship. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.