Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices – RAND – 2011

Posted on October 23, 2012. Filed under: Evidence Based Practice, Knowledge Translation, Research | Tags: , |

Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices – RAND – 2011

by Eric C. Schneider, Justin W. Timbie, D. Steven Fox, Kristin R. Van Busum, John Caloyeras

“Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Variation in the use of diagnostic tests and treatments for patients with similar symptoms or conditions has been attributed to clinical uncertainty, since the published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs. The federal government has made a dramatic investment in comparative effectiveness research (CER), with the expectation that CER will influence clinical practice and improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes in healthcare delivery and informs the choice of diagnostic and treatment strategies. This report summarizes findings from a qualitative analysis of the factors that impede the translation of CER into clinical practice and those that facilitate it. A case-study methodology is used to explore the extent to which these factors led to changes in clinical practice following five recent key CER studies. The enabling factors and barriers to translation for each study are discussed, the root causes for the failure of translation common to the studies are synthesized, and policy options that may optimize the impact of future CER — particularly CER funded through the American Recovery and Reinvestment Act of 2009 -are proposed.”

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Valuing Health Care: Improving Productivity and Quality – Ewing Marion Kauffman Foundation [US] – 19 April 2012

Posted on April 24, 2012. Filed under: Health Systems Improvement, Research | Tags: |

Valuing Health Care: Improving Productivity and Quality – Ewing Marion Kauffman Foundation [US] – 19 April 2012

“Cost trends in U.S. health care consistently increase at about 2.5 percentage points faster than the general rate of inflation – clearly an unsustainable rate. To address what it called “America’s most urgent public policy problem,” the Ewing Marion Kauffman Foundation released a report at The Atlantic’s fourth annual Health Care Forum in Washington today that focuses on improving the cost-benefit balance in American health care through open access to medical data….

The report, “Valuing Health Care: Improving Productivity and Quality,”  is based on the recommendations of 31 experts from related fields, whom the Kauffman Foundation convened to reframe thinking around the question, “How can the productivity and value of American health care be increased, in both the short-term and long-term?”

Specifically, the report recommends:

Unleashing the power of information by breaking down silos and encouraging data sharing between research centers, medical offices, pharmaceutical companies, insurance firms and others; and that a new corps of data entrepreneurs be incentivized to collect and analyze existing medical data to discover and then disseminate new therapies.
Funding more translational, cross-cutting research, with larger average grants made available to larger teams, many of them with participants from multiple institutions; and requiring collaboration across research institutions.
Reforming medical malpractice systems to streamline new drug approvals and remove counter-productive restrictions on health insurance premiums.
Empowering patients by, among other means, providing unbiased information on treatment options’ benefits and drawbacks, and helping them make choices about the relevant lifestyle implications and risk-reward tradeoffs.

Further, the task force contends, health care delivery deserves its own national research program, one focused on comparative efficiency research. More efficiency (with acceptable quality guidelines) leads to profitability, and corrects the easy practice of simply passing costs down the health care stream.”

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Using Comparative Effectiveness Research to Inform Policymaking – Commonwealth Fund – 4 April 2012

Posted on April 24, 2012. Filed under: Evidence Based Practice | Tags: , |

Using Comparative Effectiveness Research to Inform Policymaking – Commonwealth Fund – 4 April 2012

by David Squires

“Comparative effectiveness research (CER) assesses alternative treatments or diagnostic options for the same condition. Such research can prove useful for clinicians and patients as a tool to inform decisions about treatment and care. It also has potential to inform policymaking, such as decisions over which treatments to cover and at what price. In the United States, the 2009 Recovery Act for the first time provided significant funding for CER, and the 2010 Affordable Care Act went further, establishing an independent institute to commission such research—the Patient-Centered Outcomes Research Institute—with dedicated long-term funding.

Several industrialized countries have operated organizations conducting and commissioning CER for many years. In some countries these bodies are government agencies, while in others they are freestanding organizations with more independence. Policymakers often use the research these organizations generate to determine the content of publicly provided health benefits—for example, to decide whether a new drug should be covered under regional or national formularies. Other uses include negotiating pricing arrangements with drug companies or designing “value-based” cost-sharing arrangements, wherein patients pay more out-of-pocket for drugs deemed less effective than their alternative. As the Patient-Centered Outcomes Research Institute develops and CER becomes more widely available, U.S. decision-makers can learn from international experiences using CER to drive health care toward improved quality and value.”

… continues on the site

Looks at:
England’s National Institute for Health and Clinical Excellence
France’s National Authority for Health (HAS)
Germany’s Institute for Quality and Efficiency in Health Care
Australia’s Pharmaceutical Benefits Advisory Committee

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Learning What Works: Infrastructure Required for Comparative Effectiveness Research – Institute of Medicine Workshop Summary – 25 July 2011

Posted on July 26, 2011. Filed under: Evidence Based Practice | Tags: , , |

Learning What Works: Infrastructure Required for Comparative Effectiveness Research – Institute of Medicine Workshop Summary – 25 July 2011

Full text

“Evidence is the cornerstone of a high-performing healthcare system. It is essential for patients and clinicians to know which treatments work best for whom if they are to make informed, collaborative care decisions. Despite this need, only a small fraction of health-related expenditures in the U.S. have been devoted to comparative effectiveness research. Recent activities—such as the creation of the Patient-Centered Outcomes Research Institute—are beginning to address this shortfall, bringing the importance of clinical research and evidence development to the forefront of health policy discussions.

As part of its Learning Health System series of workshops, the IOM’s Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss capacity priorities to build the evidence base necessary for care that is more effective and delivers higher value for patients. Participants explored issues such as; data linkage and improvement; study coordination and results dissemination; research methods innovation; and the training and size of the workforce, all as they relate to improved medical decision making.”

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Finding What Works in Health Care: Standards for Systematic Reviews – Institute of Medicine – 2011

Posted on March 24, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Evidence Based Practice, Health Systems Improvement | Tags: , |

Finding What Works in Health Care: Standards for Systematic Reviews – Institute of Medicine – 2011

Authors:  Jill Eden, Laura Levit, Alfred Berg, and Sally Morton, Editors; Committee on Standards for Systematic Reviews of Comparative Effectiveness Research; Institute of Medicine

“Healthcare decision makers-including doctors-increasingly turn to systematic reviews for reliable, evidence-based comparisons of health interventions. Systematic reviews identify, select, assess, and syn thesize the findings of similar but separate studies. In this report, the IOM recommends stan dards for systematic reviews of the comparative effectiveness of medical or surgical interventions.”

ISBN-10: 0-309-21053-4
ISBN-13: 978-0-309-21053-9

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NEHI outlines national plan for comparative effectiveness research – 17 February 2011

Posted on February 18, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Evidence Based Practice, Health Informatics | Tags: , , |

NEHI outlines national plan for comparative effectiveness research – 17 February 2011

by Bernie Monegain, Editor

NEHI – The National Network for Health Innovation [US]

“CAMBRIDGE, MA – NEHI, an independent nonprofit national network for health innovation, Thursday proposed a national strategy for disseminating comparative effectiveness research (CER) findings that would be led by the newly created Patient-Centered Outcomes Research Institute (PCORI).

NEHI also recommends that the CER challenge extend to other federal agencies administering programs to enhance the healthcare system’s capabilities to utilize evidence, such as the Office of the National Coordinator for Health Information Technology, which is charged with implementing federal support for the deployment of electronic medical records and clinical data infrastructure.”

…continues on the site

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Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer – AHRQ – 2010

Posted on August 3, 2010. Filed under: Oncology | Tags: , |

Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

Press release  Advanced Type of Cancer Radiation Reduces Side Effects, but Impact on Controlling Cancer Is Unclear

AHRQ = Agency for Healthcare Research and Quality [US]

“An advanced type of cancer radiation is more successful than traditional radiation in avoiding “dry mouth” when treating head and neck cancers, but it is unknown whether the treatment is better or worse at reducing the size of tumors, according to a new AHRQ comparative effectiveness review.  The report finds that intensity-modulated radiation therapy (IMRT) leads to fewer cases of xerostomia, commonly known as dry mouth, than other types of radiation.  Xerostomia, a potential side effect to radiation when salivary glands are damaged, can affect basic functions like chewing, swallowing and breathing; senses such as taste, smell and hearing; and can significantly alter a patient’s appearance and voice.  However, the report did not find evidence that IMRT is more successful than any other kind of radiation therapy in reducing tumors.  Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissues, but more research is needed.  The comparative effectiveness review, Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, was authored by the Blue Cross and Blue Shield (BC/BS) Association, Technology Evaluation Center in Chicago.”

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Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions – final research review – AHRQ US – 15 December 2009

Posted on December 22, 2009. Filed under: Diagnostics, Oncology | Tags: , , |

Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions – final research review – AHRQ (US) – 15 December 2009

View PDF 697 kB

Non-surgical Method for Diagnosing Breast Cancer Safe, Nearly as Effective as Surgical Biopsy, New Report Finds
Press Release Date
: December 14, 2009

“Some methods of minimally invasive biopsy for breast cancer are nearly as accurate as surgical biopsy but have much less risk of harms, according to a new report funded by HHS’ Agency for Healthcare Research and Quality (AHRQ).

The report, prepared by the ECRI Institute’s Evidence-based Practice Center under contract to AHRQ’s Effective Health Care Program, compares traditional surgical biopsies with various types of “core needle biopsies,” which involve removing tissue through a special large hollow needle inserted through the skin.”

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Toward Reuse of Clinical Data for Research and Quality Improvement: The End of the Beginning? – editorial and 3 articles from Annals of Internal Medicine 1 September 2009

Posted on July 29, 2009. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

1.  EDITORIAL   Toward Reuse of Clinical Data for Research and Quality Improvement: The End of the Beginning?
Mark G. Weiner, MD, and Peter J. Embi, MD, MS
Annals of Internal Medicine   1 September 2009 | Volume 151 Issue 5

“Today’s health information technology (HIT) landscape provides an unprecedented convergence of comprehensive electronic health records, robust computational processing power, data sharing capabilities, and emerging financial incentives that favor the widespread adoption and meaningful use of such systems. Even as the primary value proposition for HIT adoption by clinical practices remains a matter of debate (1), 2 articles in this issue (2, 3) help to illustrate the potential for secondary benefits by discussing the value of distributed health data networks for improving research and health care quality.”  … continues

2.  An Electronic Practice-Based Network for Observational Comparative Effectiveness Research
Wilson D. Pace, MD; Maribel Cifuentes, RN, BSN; Robert J. Valuck, PhD; Elizabeth W. Staton, MSTC; Elias C. Brandt, BS; and David R. West, PhD
Annals of Internal Medicine  1 September 2009 | Volume 151 Issue 5

“The Distributed Ambulatory Research in Therapeutics Network (DARTNet) is a federated network of electronic health data from 8 organizations representing more than 500 clinicians and more than 400,000 patients. DARTNet was designed to increase knowledge of the comparative effectiveness of prescription medications and medical devices. Traditional observational comparative effectiveness research is conducted using large data sets, such as claims databases. Such databases do not provide important clinical information that is critical to understanding comparative effectiveness. By linking electronic health records, laboratory and imaging data, and administrative data from diverse and geographically disparate patients, DARTNet provides important new insight into the comparative effectiveness of oral diabetes medications, and it is ready for expansion to further enable effectiveness research.”

3.  Design of a National Distributed Health Data Network
Judith C. Maro, MS; Richard Platt, MD, MSc; John H. Holmes, PhD; Brian L. Strom, MD, MPH; Sean Hennessy, PharmD, PhD; Ross Lazarus, MBBS, MPH; and Jeffrey S. Brown, PhD
Annals of Internal Medicine   1 September 2009 | Volume 151 Issue 5

“A distributed health data network is a system that allows secure remote analysis of separate data sets, each comprising a different medical organization’s or health plan’s records. Distributed health data networks are currently being planned that could cover millions of people, permitting studies of comparative clinical effectiveness, best practices, diffusion of medical technologies, and quality of care. These networks could also support assessment of medical product safety and other public health needs. Distributed network technologies allow data holders to control all uses of their data, which overcomes many practical obstacles related to confidentiality, regulation, and proprietary interests. Some of the challenges and potential methods of operation of a multipurpose, multi-institutional, distributed health data network are described.”

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Comparative Effectiveness Review Within the U.K.’s National Institute for Health and Clinical Excellence – The Commonwealth Fund – 22 July 2009

Posted on July 23, 2009. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

K. Chalkidou, Comparative Effectiveness Review Within the U.K.’s National Institute for Health and Clinical Excellence, The Commonwealth Fund, 22 July 2009.

Overview

“The U.K.’s National Institute for Health and Clinical Excellence (NICE) was established to perform three core functions: 1) reduce unwarranted variation in practice across the United Kingdom through the development and dissemination of best practice evidence-based standards; 2) encourage fast diffusion and uniform uptake of high-value medical innovations; and 3) ensure the taxpayers’ money is invested in the National Health Service so that health benefit is maximized. NICE decisions are made by independent committees of health professionals, academics, and industry and lay representatives. More than 2,000 experts engage with NICE processes throughout the year. NICE committees consider comparative clinical and cost effectiveness, social values (including impact on equity), and U.K. and European Union legislation when making their decisions.”

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Initial National Priorities for Comparative Effectiveness Research – Institute of Medicine (US) – 30 June 2009

Posted on July 1, 2009. Filed under: Health Systems Improvement, Research | Tags: , , , , , |

Initial National Priorities for Comparative Effectiveness Research – Institute of Medicine (US) – 30 June 2009

Full text of the report from National Academies Press

“Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. Consumers, patients, and caregivers also require this information to decide how to evaluate and treat their conditions. All too often, the information necessary to inform these medical decisions is incomplete or unavailable, resulting in more than half of the treatments delivered today lacking clear evidence of effectiveness.

Comparative effectiveness research (CER) identifies what works best for which patients under what circumstances. Congress, in the American Recovery and Reinvestment Act (ARRA) of 2009, tasked the Institute of Medicine (IOM) to recommend national priorities for research questions to be addressed by CER and supported by ARRA funds. In its 2009 report, Initial National Priorities for Comparative Effectiveness Research, the authoring committee establishes a working definition of CER, develops a priority list of research topics to be undertaken with ARRA funding using broad stakeholder input, and identifies the necessary requirements to support a robust and sustainable CER enterprise. The full list of priorities and recommendations can be found in the below report brief.”

2 articles on this from the NEJM – 30 June 2009

Prioritizing Comparative-Effectiveness Research — IOM Recommendations
J.K. Iglehart

Comparative-Effectiveness Research — Implications of the Federal Coordinating Council’s Report
P.H. Conway and C. Clancy

2 articles from the Annals of Internal Medicine

Comparative Effectiveness Research: A Report From the Institute of Medicine
Harold C. Sox, MD, Editor, and Sheldon Greenfield, MD
4 August 2009  Volume 151 Issue 3  Annals of Internal Medicine

Rethinking Randomized Clinical Trials for Comparative Effectiveness Research: The Need for Transformational Change
Bryan R. Luce, PhD, MBA; Judith M. Kramer, MD, MS; Steven N. Goodman, MD, MHS, PhD; Jason Connor, PhD; Sean Tunis, MD, MSc; Danielle Whicher, MHS; and J. Sanford Schwartz, MD
4 August 2009  Volume 151 Issue 3    Annals of Internal Medicine

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