Abstract
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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Introduction
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.
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