Comparative Effectiveness Research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances.The Institute of Medicine committee has defined CER as "the generation and synthesis of evidence that 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 policy makers to make informed decisions that will improve health care at both the individual and population levels." An important component of CER is the concept of Pragmatic Trials. These clinical research trials measure effectiveness—the benefit the treatment produces in routine clinical practice. This is different than many regularly clinical trials, which measure efficacy, whether the treatment works or not.Dr.John Wennberg and his colleagues at The Dartmouth Institute for Health Policy and Clinical Practice have spent over 40 years documenting geographic variation in health care that patients in the U.S. receive - a phenomenon called practice pattern variation. The Dartmouth researchers concluded that if unwarranted variation were eliminated, the quality of care would increase and health care savings up to 30% would be possible - a statistic that has been often repeated in the case for CER.Several groups have emerged to provide leadership in the area of Comparative Effectiveness Research. The Agency for Healthcare Research and Quality (AHRQ) is a federal agency focused on health care quality, while the Center for Medical Technology Policy is a non-profit organization that brings disparate health care stake holders together to build consensus on practical models for comparative effectiveness research.
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Comparative Effectiveness Research in the 2010 Health Care Reform
The rising cost of medical care in the U.S. has triggered an immediate need for better value in our health system. Researchers at the Dartmouth Institute for Health Policy, in addition to the Congressional Budget Office, have documented a large gap in the quality and outcomes and health services being delivered. Unwarranted variation in medical treatment, cost, and outcomes suggests a substantial area for improve and savings in our health care system. Statistical findings show that "patients in the highest-spending regions of the country receive 60 percent more health services than those in the lowest-spending regions, yet this additional care is not associated with improved outcomes." New models of shared decision making promise to bringer greater emphasis to informed patient choice for "preference-sensitive" care, improving quality, safety, and effectiveness of health care by providing both patients and their health care providers with the evidence to assist in informed decision making.In 2009, $1.1 Billion of President Obama's stimulus package was earmarked for CER.. There was initial disagreement regarding whether CER will be used to limit patient health care options, or help lower health care costs.[8] Ultimately the bill approved by Senate contains measures to utilize CER as a means for increasing quality while reducing rising costs.
per saperne di piu': da yahoo , un articolo sulla medicina comparativa
Studi di efficacia comparativa? Troppo pochi! Mar 30 Mar
Qual è la presenza degli studi di efficacia comparativa, e come è articolata, sulle principali riviste generaliste? Secondo una ricerca ospitata sul JAMA, soltanto un terzo degli studi su terapie farmacologiche, tra quelli individuati, valutava l’efficacia comparativa e solo una minoranza di questi confrontava terapie farmacologiche con terapie non farmacologiche; pochi studi, inoltre, erano centrati sulla sicurezza o i costi e la maggior parte era finanziata da enti non commerciali. A differenza delle ricerche su interventi e strategie innovativi, tali studi aiutano a usare i trattamenti esistenti in modo più efficace e a individuare quali scelte sono più efficaci e per quali pazienti: secondo la definizione dell’Institute of Medicine statunitense la comparative effectiveness research (CER) è infatti “la produzione e sintesi di ricerca che valuta efficacia e rischi di interventi alternativi per la prevenzione, diagnosi, trattamento e monitoraggio di una condizione”. Un tipo di ricerca che meriterebbe più spazio e più risorse.Fonte: Hochman M, McCormick D. Characteristics of published comparative effectiveness studies of medications. JAMA 2010; 303(10): 951-958. Conway PH, Clancy C. Charting a path from comparative effectiveness funding to improved patient-centered health care. JAMA. 2010;303(10):985-986.
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Pubblicato il: 09/09/2009
Comparative Effectiveness Research: a report from the Institute of Medicine , Ann Intern Med 2009;151:203-205
“La comparative effectiveness research (CER) è la produzione e sintesi di ricerca che valuta efficacia e rischi di interventi alternativi per la prevenzione, diagnosi, trattamento e monitoraggio di una condizione clinica o per migliorare l’erogazione dell’assistenza. L’obiettivo della CER è assistere utenti, clinici e manager nel prendere decisioni evidence-based in grado di migliorare la salute degli individui e delle popolazioni”. Questa definizione apre il report dell’Institute of Medicine (IOM) che pone una nuova pietra miliare verso un programma nazionale di ricerca orientata a produrre evidenze scientifiche rilevanti per la sanità pubblicai. Nello stesso fascicolo della rivista, un commento sul report dell’IOM e un articolo sulle prospettive per migliorare la metodologia della CER.
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