Comparative Effectiveness Research Crucial To Improving Patient Care

Comparative effectiveness research is an effective means of improving quality, reducing costs and enhancing access to care, according to AAFP President Ted Epperly, M.D., of Boise, Idaho, who testified before an Institute of Medicine, or IOM, committee here on March 20.

The recently enacted American Recovery and Reinvestment Act of 2009 requires that the IOM recommend comparative effectiveness research spending priorities to the HHS secretary, who then will issue a report to Congress. In a bid to gather information for the IOM report, the IOM Committee on Comparative Effectiveness Research Priorities heard testimony on March 20, gathering information from relevant stakeholders, including the AAFP.

From the AAFP's perspective, comparative effectiveness research means "careful analysis of the relative benefits and costs of various treatments across populations and illnesses," said Epperly during his testimony. However, he added, despite the many randomized clinical trials conducted each year, "there is still a surprisingly large gap between what we know and what we need to know to provide optimal care."

"Given the complexities of clinical care and the numerous treatment options -- as a nation, we cannot expect, afford or, in many cases, ethically conduct all the randomized clinical trials that would be needed to fill in existing gaps in knowledge," he said.

For example, said Epperly, the Agency for Healthcare Research and Quality recently found gaps in medical knowledge about such highly prevalent conditions as diabetes and depression. Because family physicians have a broad scope of practice, they often care for individuals with these chronic conditions and constantly deal with these knowledge gaps, he said.

According to Epperly, many AAFP members are interested in participating in large-scale comparative effectiveness studies. And the implications of having more than 100,000 FPs pulling clinical data on 280 million patient visits per year are profound. It would offer a unique way of looking at common issues and questions and developing answers, he added.

Epperly stressed, however, that any comparative effectiveness research must include all aspects of different populations and should be done in rural, urban and suburban areas. Comparative effectiveness studies also should look at systems of care, such as the patient-centered medical home, as well as individual medications and treatments, he added.

Epperly also told the committee about the Distributed Network for Ambulatory Research in Therapeutics, or DARTNet, public/private consortium in which the AAFP has played a leading role. DARTNet uses electronic health records, practice-based networks and practical clinical trials to advance comparative effectiveness research.

"Through DARTNet, we are examining how electronic data from a patient's medical home can expand our knowledge of high-quality care," Epperly said during his testimony.

DARTNet physicians are studying the care they provide and learning from best practices. The information they elicit will improve care at the practice level and enable family physicians to undertake the most clinically and economically effective therapies, Epperly said.

Inevitably, comparative effectiveness research will demonstrate that some therapies will work better than others, prompting challenges and opposition from some, said Epperly. However, he noted, the Academy believes "the health of the public should trump individual business concerns."

Although some entities have criticized comparative effectiveness research, the AAFP believes those concerns are unfounded, said Epperly, "We do not believe comparative effectiveness research will lead to arbitrary regulation, rationing or limits."