Comparative Effectiveness Research

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally – The Commonwealth Fund – 16 June 2014

Posted on June 16, 2014. Filed under: Comparative Effectiveness Research, Health Mgmt Policy Planning | Tags: |

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally – The Commonwealth Fund – 16 June 2014

“Executive Summary

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. It includes information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013). It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).”

… continues on the site

Advertisements
Read Full Post | Make a Comment ( Comments Off on Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally – The Commonwealth Fund – 16 June 2014 )

The four health systems of the UK: How do they compare? – Nuffield Trust – 11 April 2014

Posted on April 14, 2014. Filed under: Comparative Effectiveness Research, Health Mgmt Policy Planning, Health Policy, Health Systems Improvement | Tags: |

The four health systems of the UK: How do they compare? – Nuffield Trust – 11 April 2014

“This report, published by the Nuffield Trust and the Health Foundation, assesses the performance of the NHS on the quality of patient care in all four UK countries since devolution.

Summary

Since political devolution in 1999, there has been increasing policy divergence between the health systems of the four countries of the United Kingdom (UK). This report attempts to update earlier comparisons of the publicly financed health systems of England, Scotland, Wales and Northern Ireland in terms of funding, inputs and performance before and since devolution.

It also includes comparisons with the North East of England, which has been chosen as a better comparator with the three devolved nations than England as a whole.”

… continues on the site

 

Read Full Post | Make a Comment ( Comments Off on The four health systems of the UK: How do they compare? – Nuffield Trust – 11 April 2014 )

Design and Implementation of N-of-1 Trials: A User’s Guide – AHRQ – 12 February 2014

Posted on February 26, 2014. Filed under: Comparative Effectiveness Research, Research | Tags: |

Design and Implementation of N-of-1 Trials: A User’s Guide – AHRQ – 12 February 2014

AHRQ = US Agency for Healthcare Research and Quality

“Design and Implementation of N-of-1 Trials: A User’s Guide provides information on the design and implementation of n-of-1 trials (a.k.a. single-patient trials), a form of prospective research in which different treatments are evaluated in an individual patient over time. The apparent simplicity of this study design has caused it to be enthusiastically touted in some research fields and yet overlooked, underutilized, misunderstood, or erroneously implemented in other fields. With the advent of comparative effectiveness research and patient-centered outcomes research, there is a renewed interest in n-of-1 trials as an important research method for generating unique scientific evidence on patient health outcomes. A core aspect of this interest is that the n-of-1 approach may overcome some important limitations of other methodologies that involve larger samples of subjects. As a result, findings from n-of-1 trials may be especially useful in informing key health care decisions by patients and providers, particularly when combined with other scientific evidence. Likewise, the expansion of electronic health information technology into all areas of clinical care and the increasing recognition that new systems may also be deployed for research and quality improvement have further driven interest in conducting more n-of-1 trials as part of a learning health care system.

AHRQ commissioned this User’s Guide as an informational resource to researchers, health care providers, patients, and other stakeholders to improve general understanding of n-of-1 trials and strengthen the quality of evidence that is generated when an n-of-1 trial is conducted. The overarching aim of this User’s Guide is to guide readers by identifying key decisions and tradeoffs in the design and implementation of n-of-1 trials, particularly when used for patient-centered outcomes research. Patient-centered outcomes research includes investigations of a wide range of research problems, particularly studying the outcomes, effectiveness, benefits, and harms of diagnostic tests, treatments, procedures, or health care services. This User’s Guide identifies key elements to consider in applying the n-of-1 trial methodology to patient-centered outcomes research, describes some of the important complexities of the method, and provides readers with checklists to summarize the main points.”

… continues on the site

Read Full Post | Make a Comment ( Comments Off on Design and Implementation of N-of-1 Trials: A User’s Guide – AHRQ – 12 February 2014 )

Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Posted on February 5, 2014. Filed under: Anaesthesiology, Comparative Effectiveness Research, Surgery | Tags: |

Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Balk EM, Earley A, Hadar N, Shah N, Trikalinos TA. Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness. Comparative Effectiveness Review No. 130. (Prepared by Brown Evidence-based Practice Center under Contract No. 290-2012-0012-I.) AHRQ Publication No. 14-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2014.

“Structured Abstract

Objectives. Preoperative testing is used to guide the action plan for patients undergoing surgical and other procedures that require anesthesia and to predict potential postoperative complications.There is uncertainty whether routine or per-protocol testing in the absence of a specific indication prevents complications and improves outcomes, or whether it causes unnecessary delays, costs, and harms due to false-positive results.

Data sources. We searched MEDLINE® and Ovid Healthstar® (from inception to July 22, 2013), as well as Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews.

Review methods. We included comparative and cohortstudies of both adults and children undergoing surgical and other procedures requiring either anesthesia or sedation (excluding local anesthesia). We included all preoperative tests that were likely to be conducted routinely (in all patients) or on a per-protocol basis(in selected patients). For comparative studies, the comparator of interest was either no testing or ad hoc testing done at the discretion of the clinician. We also looked for studies that compared routine and per-protocol testing. The outcomes of interest were mortality, perioperative events, complications, patient satisfaction, resource utilization, and harms related to testing.

Results. Fifty-seven studies (14 comparative and 43 cohort) met inclusion criteria for the review. Well-conducted randomized controlled trials (RCTs) of cataract surgeries suggested that routine testing with electrocardiography, complete blood count, and/or a basic metabolic panel did not affect procedure cancellations (2 RCTs, relative risks [RRs] of 1.00 or 0.97), and there was no clinically important difference for total complications (3 RCTs, RR = 0.99; 95% confidence interval, 0.86 to 1.14). Two RCTs and six nonrandomized comparative studies of general elective surgeries in adults varied greatly in the surgeries and patients included, along with the routine or per-protocol tests used. They also mostly had high risk of bias due to lack of adjustment for patient and clinician factors, making their results unreliable. Therefore, they yielded insufficient evidence regarding the effect of routine or per-protocol testing on complications and other outcomes. There was also insufficient evidence for patients undergoing other procedures. No studies reported on quality of life, patient satisfaction, or harms related to testing.

Conclusions. There is high strength of evidence that, for patients scheduled for cataract surgery, routine preoperative testing has no effect on total perioperative complications or procedure cancellation. There is insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. There is no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing and no evidence regarding other factors that may affect the balance of benefits and harms. The findings of the cataract surgery studies are not reliably applicable to other patients undergoing other higher risk procedures. Except arguably for cataract surgery, numerous future adequately powered RCTs or well-conducted and analyzed observational comparative studies are needed to evaluate the benefits and harms of routine preoperative testing in specific groups of patients with different risk factors for surgical and anesthetic complications undergoing specific types of procedures and types of anesthesia.”

Read Full Post | Make a Comment ( Comments Off on Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014 )

Paying Wisely: Reforming Incentives to Promote Evidence-Based Decisions at the Point of Care – Center on Health Care

Posted on November 20, 2012. Filed under: Comparative Effectiveness Research, Evidence Based Practice, Health Economics |

Paying Wisely: Reforming Incentives to Promote Evidence-Based Decisions at the Point of Care – Center on Health Care
Effectiveness – October 2012

Extract

“Congress has invested heavily in comparative effectiveness research in order to augment the clinical information that patients and physicians need to make sound decisions at the point of care. The availability of research evidence alone, however, does not guarantee that it will be used to make decisions (Timbie et al. 2012; Esposito et al. 2010). We know,   for example, that many evidence-based services are underused and that many practices persist despite a lack of evidence for their effectiveness (McGlynn et al. 2003).

In response, policymakers are looking to reform financial incentives in the fee-for-service physician payment system to encourage evidence-based care—that is, decisions based on evidence of treatment effectiveness. Although various proposals to reform provider incentives have been put forth, most focus on transforming the organization and coordination of health care at the system level rather than on how to reward an individual clinician’s use of evidence at the point of care. This paper adds an important perspective by describing how current financial incentives in the fee-for-service system lead to the overuse and underuse of services at the point of care by physicians and other clinicians. It also explores how prominent payment reform options may reward more evidence-based clinical decisions. Based on this analysis, we conclude that a combination of payment reforms—grounded in re-calibrated FFS incentives—may be the most effective way to enhance evidence-based decision making at the point of care.”

Read Full Post | Make a Comment ( Comments Off on Paying Wisely: Reforming Incentives to Promote Evidence-Based Decisions at the Point of Care – Center on Health Care )

Treatment Strategies for Women With Coronary Artery Disease – Agency for Healthcare Research and Quality [US] – August 2012

Posted on August 30, 2012. Filed under: Cardiol / Cardiothor Surg, Comparative Effectiveness Research | Tags: |

Treatment Strategies for Women With Coronary Artery Disease – Agency for Healthcare Research and Quality [US] – August 2012

Dolor RJ, Melloni C, Chatterjee R, Allen LaPointe NM, Williams JB Jr., Coeytaux RR, McBroom AJ, Musty MD, Wing L, Samsa GP, Patel MR.
Treatment Strategies for Women With Coronary Artery Disease. Comparative Effectiveness Review No. 66.
(Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 12-EHC070-EF Rockville, MD. Agency for Healthcare Research and Quality. August 2012

“Structured Abstract

Objectives. Although coronary artery disease (CAD) is the leading cause of death for women in the United States, treatment studies to date have primarily enrolled men and may not reflect the benefits and risks that women experience. Our systematic review of the medical literature assessed the comparative effectiveness of major treatment options for CAD specifically in women. The comparisons were (1) percutaneous coronary intervention (PCI) versus fibrinolysis/supportive pharmacologic therapy in ST elevation myocardial infarction (STEMI), (2) early invasive versus initial conservative management in non-ST elevation myocardial infarction (NSTEMI) or unstable angina, and (3) PCI versus coronary artery bypass surgery (CABG) versus optimal medical therapy in stable or unstable angina. The endpoints assessed were clinical outcomes, modifiers of effectiveness by demographic and clinical factors, and safety outcomes.”

… continues on the site

Read Full Post | Make a Comment ( Comments Off on Treatment Strategies for Women With Coronary Artery Disease – Agency for Healthcare Research and Quality [US] – August 2012 )

Hospital Survey on Patient Safety Culture – The Agency for Healthcare Research and Quality (AHRQ) – April 2011

Posted on April 29, 2011. Filed under: Comparative Effectiveness Research, Patient Safety | Tags: |

Hospital Survey on Patient Safety Culture – The Agency for Healthcare Research and Quality (AHRQ) – April 2011
2011 User Comparative Database Report

“Based on data from 1,032 U.S. hospitals, the Hospital Survey on Patient Safety Culture: 2011 User Comparative Database Report provides initial results that hospitals can use to compare their patient safety culture to other U.S. hospitals. In addition, the 2011 report presents results showing change over time for 512 hospitals that submitted data more than once. The report consists of a narrative description of the findings and four appendixes, presenting data by hospital characteristics and respondent characteristics for the database hospitals overall and separately for the 512 trending hospitals.”

… continues on the site

Read Full Post | Make a Comment ( None so far )

AHRQ’s Effective Health Care Program Data Points Publication Series Available

Posted on April 5, 2011. Filed under: Comparative Effectiveness Research, Evidence Based Practice | Tags: |

AHRQ’s Effective Health Care Program Data Points Publication Series Available

Agency for Healthcare Research and Quality [US]

“The DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network announces a new publication series Data Points that will be available on AHRQ’s Effective Health Care Program Web site. This series will offer new information and insights on the use of health care services and interventions for the treatment, management, and diagnosis of diseases, as well as the variations and potential disparities across patient subpopulations.  Reports will provide brief descriptive statistics, background information, and analytic tables on a variety of specific, focused topics related to medical diagnoses, treatments, services, and patient populations.  Specific reports will present new statistics on topics such as disease incidence, prevalence, and burden of illness, as well as outcomes such as readmission, morbidity, and mortality.  The publication series will generally summarize the basic demographic and geographic breakdowns with additional details available in statistical tables that can be downloaded from the Effective Health Care Program Web site.  The first Data Points reports describe the incidence and prevalence of diabetic foot ulcers and some of its major complications in Medicare beneficiaries.  Three reports are now available on the Effective Health Care Program Web site. “

Read Full Post | Make a Comment ( None so far )

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches – Workshop Summary – Institute of Medicine – 6 December 2010

Posted on January 19, 2011. Filed under: Comparative Effectiveness Research, Research | Tags: , |

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches – Workshop Summary – Institute of Medicine – 6 December 2010

“Currently, a substantial gap exists between the knowledge needed and that available for medical care decisions—and that gap is growing larger. Approaches to clinical research are being substantially outpaced by the rapid growth in new health care diagnostic and treatment options and an explosion of new genetics insights that hold real implications for the potential – and the need – to personalize individual interventions. Advances in informatics, large scale data sets, and clinical research methods to assess those data sets hold promise for considerably accelerating the pace, reliability, and applicability of clinical effectiveness research. 

To help consider these issues, the IOM Roundtable on Value & Science-Driven Health Care sponsored a meeting to explore the methods, data resources, tools, and techniques that are emerging in the new generation of accelerated clinical research approaches.  This publication of the discussions, Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches, summarizes issues related to the magnitude of the need for better information, the opportunities to align research and practice, and the potential for emerging research and data networks, innovative approaches to study design, analysis, and modeling.  This publication is the most recent in the Roundtable’s Learning Health System Series in which each volume represents a basic element in the movement towards a system in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing and natural by-product of the care experience, and to seamlessly refine and deliver best practices for continuous improvement in health and health care.”

Read Full Post | Make a Comment ( None so far )

Comparative Effectiveness Research: A Progress Report – 2010

Posted on October 5, 2010. Filed under: Comparative Effectiveness Research | Tags: |

Comparative Effectiveness Research: A Progress Report
Harold C. Sox, MD
Ann Intern Med. 2010;153:469-472.
 
“Sixteen months ago, comparative effectiveness research (CER) began its rapid rise, when the American Recovery and Reinvestment Act of 2009 allocated $1.1 billion for CER. This progress report summarizes how the recipients of the funds—the National Institutes of Health, Agency for Healthcare Research and Quality, and Office of the Secretary of the U.S. Department of Health and Human Services—are spending the $1.1 billion, how the Institute of Medicine priority topics have fared in the agencies’ funding programs, and the developing plans for a national CER program. As the United States works to absorb 32 million currently uninsured people into the health care system while simultaneously improving the quality of care and slowing cost increases, CER will increasingly be a necessary component of this change.”

Read Full Post | Make a Comment ( None so far )

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary – 2010

Posted on October 5, 2010. Filed under: Comparative Effectiveness Research, Evidence Based Practice, Research | Tags: |

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary – 2010

LeighAnne Olsen and J. Michael McGinnis; Roundtable on Value & Science-Driven Health Care; Institute of Medicine

ISBN-10: 0-309-11988-X
ISBN-13: 978-0-309-11988-7

Extract from the description:

“The Institute of Medicine Roundtable on Value & Science-Driven Health Care’s vision for a learning healthcare system, in which evidence is applied and generated as a natural course of care, is premised on the development of a research capacity that is structured to provide timely and accurate evidence relevant to the clinical decisions faced by patients and providers. As part of the Roundtable’s Learning Healthcare System series of workshops, clinical researchers, academics, and policy makers gathered for the workshop Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches. Participants explored cutting-edge research designs and methods and discussed strategies for development of a research paradigm to better accommodate the diverse array of emerging data resources, study designs, tools, and techniques. Presentations and discussions are summarized in this volume.”

Read Full Post | Make a Comment ( None so far )

Report to the President and the Congress on Comparative Effectiveness Research – US Department of Health and Human Services – 30 June 2009

Posted on October 4, 2010. Filed under: Comparative Effectiveness Research, Evidence Based Practice |

Report to the President and the Congress on Comparative Effectiveness Research – US Department of Health and Human Services – 30 June 2009

The Annual Report on Comparative Effectiveness Research contains information describing current Federal activities on comparative effectiveness research and recommendations for such research conducted or supported from funds made available by the Recovery Act.

Comparative Effectiveness Research Funding

Read Full Post | Make a Comment ( None so far )

Liked it here?
Why not try sites on the blogroll...