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How Will Comparative Effectiveness Research Affect the Quality of Health Care?

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Document date: February 15, 2010
Released online: March 03, 2010


Building on the American Recovery and Reinvestment Act of 2009, health reform legislation would develop an infrastructure for the ongoing generation and dissemination of information on the comparative effectiveness, where "comparative effectiveness" has been defined as the study of methods to prevent, diagnoses, treat, and monitor A clinical condition or improve delivery of care to assist consumers, clinicians, purchasers, and policy makers to make informed decisions to improve health care at both individual and population levels. The issue brief explores the concept and describes areas of controversy that need to be addressed to make comparative effectiveness research successful.

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Reflecting the view currently popular among analysts that the U.S. health system could benefit from the generation and use of more information on the comparative effectiveness (CE) of alternatives for treating and preventing health conditions, the American Recovery and Reinvestment Act of 2009 (ARRA) took steps towards creating a bigger role for research on CE in the U.S. health system. Congressional health reform proposals would go further to develop an infrastructure for the ongoing prioritization, generation, coordination and dissemination of information on comparative effectiveness. As to how the information is to be used and by whom, with what sorts of institutional supports, very little has been agreed upon, and many of the most promising options for influencing health care practice are subject to strong objections from stakeholders.

Debates about raising the profile of CE have generated a lot of controversy and left open a number of decisions that will determine its impact on health care delivery, quality of care and outcomes. The public debate on these unresolved issues continues, even as public- and private-sector actors move forward to implement those decisions that have been made. The effect gives the impression of a group of travelers starting off on a journey by making a big investment in travel gear, but with disagreement on the intended final destination and the intent to buy a map and to make hotel reservations and transport arrangements along the way. One hopes that it proves to be a rewarding trip, but fears that the failure to plan in advance is likely to result in worthless detours.

This issue brief aims to further the ongoing policy debate by investigating the implications for U.S. health care of an increased role for comparative effectiveness research and related activities. It considers the specific hopes and fears of experts and stakeholders with respect to the prospective impact of CE on quality and outcomes, and evaluates the basis for those beliefs. It looks at what policy options are on the table, and the implications of various alternatives for quality and outcomes of health care. In so doing, it draws on lessons from U.S. and international experience with CE.

(End of excerpt. The Entire Report is available in PDF format.)

Topics/Tags: | Health/Healthcare

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