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The State of Comparative Effectiveness Research and the Environment for Decision-Making (2011)

Comparative effectiveness research (CER) has gained in national prominence in recent years through an infusion of federal funds and passage of the Patient Protection and Affordable Care Act (PPACA), which established the non-profit Patient-Centered Outcomes Research Institute (PCORI) to oversee this important research.  Although PPACA is still facing challenges in the courts and Congress, many provisions of the law, including the establishment of PCORI, are already being implemented. While this foundational work is underway, the National Pharmaceutical Council, working with the public health research firm Social & Scientific Systems (SSS), examined the environment for health care decisions, especially the current state of CER and its impact on medical decision-making.

The purpose was to set a baseline for where key stakeholders believe we are today on CER and for tracking progress and judging future effects. According to the findings, there is clear recognition among key health care influentials about the importance of CER and its promise for the future. These stakeholders also expressed tempered optimism about progress in efforts to provide or improve the tools necessary for this research, and that any significant effects of CER are yet to be realized, and much work remains to be done.

CER Survey Highlights:

CER has “arrived” as a key issue in the health care conversation.

  • Nearly 6 in 10 of survey respondents were “very familiar” with comparative effectiveness research and about 30 percent of respondents were “somewhat familiar” with CER
  • CER was cited as “very important” to three-quarters of respondents or their organizations
  • Roughly one-third were “very familiar” with the Patient-Centered Outcomes Research Institute

Stakeholders feel we are moving gradually, but in the right direction, in establishing CER.

  • Respondents acknowledge that there is a greater availability of research methods and standards, as well as improvements in research priorities addressing treatment choices faced by patients and providers.
  • Respondents felt there was increasing movement from solely considering clinical effectiveness to evaluating a fuller picture of quality of life, workplace productivity effects, quality of care and the potential for improved adherence to treatments.

Stakeholders feel that over time CER will likely improve health care; however changes have not substantially taken root yet and the full impact may require significantly more time.

  • Only 30 percent believed that CER would lead to moderate improvements in health care decision-making in the next year.

Stakeholders recognize the key players on CER

  • Overwhelmingly, surveyed stakeholders believe that AHRQ will continue to play a significant role in CER during the next five years, particularly in the development of research standards (78 percent) and priorities (74 percent), with NIH (64 percent; 69 percent) and PCORI (50 percent; 63 percent) also taking an active role.
  • PCORI’s slightly lower positioning on establishing research standards may reflect the newness of the organization and its need to communicate goals and mission to audiences.

Respondents have clear expectations on the entities that will fund and conduct CER

  • Survey respondents said that the role of funding CER fell most significantly to NIH (81 percent), AHRQ (74 percent), and the pharmaceutical and medical products industry (68 percent).
  • In terms of conducting CER, respondents overwhelmingly pointed to academia (85 percent) as the main driver, followed by the pharmaceutical/medical products industry (62 percent).

CER Survey Parameters:

The survey, conducted from November 2010-March 2011, targeted key stakeholders who have an impact on, or are affected by, research involving medical effectiveness, including government, researchers, insurers, employers, human resource consultants and healthcare coalitions, and trade and other groups. A total of 118 stakeholders participated.

Survey materials:

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