February 16, 2015
experts expressed frustration that efforts to reform the health care system so rarely relied on the most rigorous methods of evaluation.
“It’s very low,” said Jon Baron, president of the Coalition for Evidence-Based Policy, a nonprofit group in Washington, referring to the main finding. He pointed out that President Obama’s Affordable Care Act had unleashed change across the health care system, including funding experiments to improve how care is delivered and paid for, but that very little of that effort had used the randomized design.
“At the end of the day,” Mr. Baron said, “they will have very little definitive evidence about whether these great innovations they are funding are actually working.”
via Few Health System Studies Use Top Method, Report Says – NYTimes.com.
August 2, 2014
Part of this story is an illustration of what happens when grants are filtered through a Federal process that is invariably politicized, and influenced, if not spearheaded by an insular crowd of academic types who are the main beneficiaries of the grants. Partly, it’s another illustration of the inefficiency and excesses that must be tolerated any time money is funneled through a government payment system. But mostly, it’s another expression of Obamacare’s false promises.
PCORI has attracted a skilled leadership team that rivals many similar private institutions. But even with its talent, and its $3.5 billion, ten-year trust fund – financed off a tax on Medicare and private health plans – PCORI never had enough resources to fund the rigorous kinds of clinical trials that would actually inspire change in clinical practice. It never aimed to make grants on a scale to accomplish this mission. It’s proponents and opponents alike didn’t want it to. Proponents didn’t really want definitive clinical answers, just policy screeds that government payers could peg decisions to. And opponents didn’t really want to see it work at all.
via Patient-Centered Outcomes Research Institute’s efforts could leave Obamacare boosters stressed out – Health – AEI.
June 17, 2014
A little-known government research agency with limited funding is engaging in one of the most ambitious medical data-gathering projects to date. The Patient-Centered Outcomes Research Institute PCORI is aiming to integrate patient data from 29 health data networks across the country to provide a diverse, national, ready-made database of information that can be used in comparative effectiveness research CER studies without the need to search for and recruit new participants. By mid-2015, PCORI plans to have PCORNet, the National Patient-Centered Clinical Research Network, operational and ready to support CER studies.
via New National Database Could Revolutionize Comparative Effectiveness Research.
February 17, 2014
The Obama administration has made a major investment in comparative effectiveness research (CER) to learn what treatments work best for which patients. CER has the potential to reduce wasteful medical spending and improve patient outcomes, but the political sustainability of this initiative remains unclear because of concerns that it will threaten the doctor-patient relationship. An unresolved question is whether it is possible to boost public support for the use of CER as a cost-control strategy. We investigate one potential source of public support: Americans’ trust in physicians as faithful agents of patient interests. We conducted two national surveys to explore the public’s confidence in doctors compared to other groups. We find that doctors are viewed as harder workers, more trustworthy, and more caring than other professionals. Through survey experiments, we demonstrate that the support of doctors’ groups for proposals to control costs and use CER have a greater influence on aggregate public opinion than do cues from political actors including congressional Democrats, Republicans, and a bipartisan commission. Our survey results suggest that the medical profession’s stance will be an important factor in shaping the political viability of efforts to use CER as a tool for health care cost control.
via Doctor Knows Best: Physician Endorsements, Public Opinion, and the Politics of Comparative Effectiveness Research.
February 17, 2014
Efforts to support and use comparative effectiveness research (CER), some more successful than others, have been promulgated at various times over the last forty years. Following a resurgence of interest in CER, recent health care reforms provided substantial support to strengthen its role in US health care. While CER has generally captured bipartisan support, detractors have raised concerns that it will be used to ration services and heighten government control over health care. Such concerns almost derailed the initiative during passage of the health care reform legislation and are still present today. Given recent investments in CER and the debates surrounding its development, the time is ripe to reflect on past efforts to introduce CER in the United States. This article examines previous initiatives, highlighting their prescribed role in US health care, the reasons for their success or failure, and the political lessons learned. Current CER initiatives have corrected for many of the pitfalls experienced by previous efforts. However, past experiences point to a number of issues that must still be addressed to ensure the long-term success and sustainability of CER, including adopting realistic aims about its impact, demonstrating the impact of Patient-Centered Outcomes Research Institute (PCORI) and communicating the benefits of CER, and maintaining strong political and stakeholder support.
via The Politics of Comparative Effectiveness Research: Lessons from Recent History.
February 16, 2014
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.
via Design and Implementation of N-of-1 Trials: A User’s Guide – Research Report – Final | AHRQ Effective Health Care Program.
February 4, 2014
In more and more countries, ratings of medicines have become part of the already lengthy process that stands between new treatments and the patients who might be helped. Some ratings take the form of medical-benefit or innovation scales that try to predict the contributions of new medicines to health outcomes, often by comparing new and existing treatments.
In France, for example, the so-called Medicines Evaluation Commission uses a five-point scale ranging from “no improvement” to “major innovation” to rank new medicines against treatments already in use. A recent study of all 10 cancer medicines launched between 2003 and 2005 found that not a single one received a “major innovation” rating from French authorities—though several went on to become widely recognized standards of care.
Other systems—such as England’s—place the new medicines on cost-benefit curves, declaring whether or not they have met certain thresholds before the National Health Service will pay for them. These efforts are known as Health Technology Assessment or comparative-effectiveness research, or CER. Thanks to ObamaCare, CER now is heavily funded in the U.S. It is intended to evaluate established treatments but could evolve quickly into a gate-keeping system….
These efforts have two critical problems. First, it is almost impossible to predict the ultimate value of new treatments before they have been used widely in the actual practice of medicine. Second, expectations about outcomes that dismiss what appear to be small improvements ignore the very nature of progress against cancer. Science, medicine and public-health efforts have moved forward against cancer not in giant leaps but incrementally.
via John C. Lechleiter: How to Win the Super Bowl Against Cancer – WSJ.com.