AAFP Weighs In on Comparative Effectiveness Research Proposals

In a recent letter to a key Senate committee, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., reiterated the Academy's strong support for high-quality comparative effectiveness research, saying, "If we wish to improve patient care and control costs in this country, this type of research is crucial.

"It is only with (comparative effectiveness research) that we can provide evidence-based information to patients and physicians for use in making health care decisions," said King, in a letter to the Senate's Health, Education, Labor and Pensions, or HELP, Committee.

The committee recently introduced a health care reform bill, The Affordable Health Choices Act (615-page PDF; About PDFs), that would establish a Center for Health Outcomes Research and Evaluation to "collect, conduct, support and synthesize research with respect to comparing health outcomes, effectiveness and appropriateness of health care services and procedures." According to the legislation, the center would identify ways to most effectively prevent, diagnose, treat and clinically manage diseases, disorders and health conditions.

In his letter to the HELP committee, King voiced the Academy's strong support for the intent of such a center. "Despite trials that are conducted each year around the world, there is still a surprisingly large gap between what we know and what we need to know to provide optimal care," King said. "This is true even in highly prevalent illnesses, such as diabetes and depression."

According to the HELP committee legislation, the Center for Health Outcomes Research and Evaluation will be tasked with using "a broad range of methodologies, including randomized controlled clinical trials, observational studies and other approaches," to achieve its goals.

Among those other approaches, said King, should be practice-based network research. "(Practice-based) research must be used in tandem with controlled clinical trials to produce the real-world information (needed) by physicians in their practices."

In his letter, King also suggested additions to the composition of a comparative effectiveness advisory council called for in the legislation. Such an advisory council needs to include clinical researchers who conduct practice-based network research, he said.

"Given the complexities of clinical care and the multitude of treatment options available for many conditions, 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 the existing gaps in knowledge," said King in his letter.

In an effort to address that situation, the AAFP has played a leading role in a public/private consortium of institutions that is developing new approaches to comparative effectiveness research, according to King. The Distributed Ambulatory Research in Therapeutics Network, or DARTNet, consists of hundreds of family physicians and other primary care physicians whose goal is to demonstrate that practice-based network research must be used in tandem with traditional clinical trials, said King.

"Through DARTNet, the AAFP is seeking to improve the quality and safety of medical care by collecting and sharing clinical data and best practices," King said. "This program uses electronic health records, practice-based research networks and practical clinical trials to advance comparative effectiveness research."

Using information from the network, the AAFP is examining how using electronic data from a patient's medical home can inform and expand physicians' knowledge of effective and safe medical care, King said.

In his letter, King praised provisions in the recently enacted American Recovery and Reinvestment Act that support aggressive comparative effectiveness studies through the Agency for Healthcare Research and Quality and the NIH.

"We believe these additional dollars likely will lead to important advances in our knowledge, and in a relatively short time," said King. "However, we also realize that (comparative effectiveness research) must be ongoing and that we will not answer all questions in the next few years.

"We recommend continued funding of (comparative effectiveness research) as a means to improved health care in this country."