The Institute of Medicine (IOM) Committee on Comparative Effectiveness Research (CER) released its recommendations today for setting health care priorities for research and funding by the U.S. government. Co-chairs of the committee, Harold C. Sox, MD, MACP, former president of the American College of Physicians (ACP) and current editor of Annals of Internal Medicine, and Sheldon Greenfield, MD, Donald Bren Professor of Medicine and executive director, Health Policy Research Institute, University of California, Irvine, have published a commentary on the report online today at www.annals.org. The Appendix section of the commentary provides full text of the IOM committee’s recommendations. A corresponding perspective piece on better research methods for CER is being published at the same time.
According to the committee definition, CER compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policymakers to make informed decisions that will improve health care at both the individual and population levels. This is important because the U.S. Congress is currently debating legislation that would guarantee health insurance to more Americans. The goal of the legislation is to moderate the rate at which the cost of health care increases while improving the quality of care for patients. Many leaders believe that reaching this goal will require a sustained effort to produce better evidence from which health care providers and payers can base their decisions.
“Some consider the $1.1 billion allocated by the government to be a down payment on a national program of CER,” said Dr. Sox. “Our committee made several recommendations aimed at creating a sustainable, trustworthy national CER initiative that could improve our health care system for individual patients and the community as a whole.”
The IOM committee report provides independent guidance from medical professionals and the public to Congress and the secretary of the U.S. Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care. To develop its report, the committee sought advice about which health topics on which CER efforts should focus from a broad range of stakeholders. Within a three-week period, the committee received more than 2,606 nominations from 1,758 individual responders. Using a three-step voting process, the committee identified 100 high-priority topics. Table 5-1 in the committee report lists the 100 highest-ranked topics. The report is available at www.iom.edu/cerpriorities.com.
According to Dr. Sox, a national CER program will be perceived as successful if it funds research that improves the uptake of new knowledge and its translation into better decision making.
“Whether the CER initiative can realize its potential to improve health care depends on other features of health care reform legislation, the profession’s ability to mobilize the best in its members, and the ability of individual patients to engage their physicians in a dialogue about their own care,” said Dr. Sox. “We believe a national initiative that engages the medical profession and patients justifies a large public investment in CER.”
In a corresponding perspective piece, Bryan R. Luce, PhD, MBA, and colleagues discuss approaches that could improve the government’s CER initiative. They suggest methods for more efficiently generating valid, generalizable evidence from randomized clinical trials (RCTs), as this kind of research is crucial to the health care decision making process. According to the researchers, RCTs offer reliable information and must have a prominent place in the CER agenda. They recommend improving approaches to conducting RCTs so they are better suited to meet the needs of CER. Study authors feel that without changes in how researchers conceive, design, conduct, and analyze RCTs, the nation risks spending large sums of money inefficiently to answer the wrong questions through CER. Full text of the study is available today online at www.annals.org.
The American College of Physicians (www.acponline.org) is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 128,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.
Annals of Internal Medicine (www.annals.org) is one of the five most widely cited peer-reviewed
medical journals in the world. The journal has been published for 82 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (www.acponline.org), the largest medical specialty organization and the second-largest physician group in the United States.