Editorial Suggests Comparative Effectiveness Research Initiatives Fall Short without Commitment to Implementation
- Federal comparative effectiveness research (CER) initiatives will fall short unless they include a commitment to implementation research to help translate findings into high-quality health care.
- An implementation research and development program could fulfill three important objectives: 1) accelerate the translation of evidence into everyday care; 2) enhance opportunities for healthcare providers and patients to define value (balancing expected benefits with costs); and 3) provide the means for providers and patients to communicate with researchers and policymakers about clinically important issues earlier in the research process.
- Three programs already exist as models for achieving the aforementioned objectives: 1) VA’s Quality Enhancement Research Initiative (QUERI), 2) VA’s Center for Implementation Practice and Research Support, and 3) the Agency for Healthcare Research and Quality’s (AHRQ) John M. Eisenberg Clinical Decisions and Communications Science Center.
On February 17, 2009, President Obama signed into law an initiative providing $1.1 billion to support research on the comparative effectiveness of drugs, medical devices, surgical procedures, and other treatments for various conditions. Although CER funding has increased, the translation of this investment into practice is very slow, and little attention has been paid to a critical question regarding CER – Will its results significantly improve the quality and safety of the healthcare received by the average patient? For example, policymakers and funders often assume that the final steps in the translation of research – the decision to act on new medical evidence and its implementation into routine care – are seamless and automatic. In reality, changing the behavior of physicians and patients can be very difficult and time consuming. This Editorial focuses on the issue of translating evidence into practice, as well as existing programs that can serve as models for achieving important implementation research objectives.
Drs. Naik and Petersen are part of HSR&D’s Houston Center for Quality of Care and Utilization Studies. Dr. Petersen also is part of Ischemic Heart Disease QUERI.
Naik A and Petersen L. The Neglected Purpose of Comparative-Effectiveness Research. The New England Journal of Medicine May 7, 2009;360(19):1929-31.