IOM Compiles List of Comparative Effectiveness Research Priorities
Strategies Would Impact Physicians, Patients
By James Arvantes
7/7/2009
The Institute of Medicine, or IOM, has identified 100 health-related topics that it says should get priority attention from a new federal investment in comparative effectiveness research.
The June 2 IOM report (7-page PDF; About PDFs) is intended to provide independent guidance to Congress and the secretary of HHS on how to spend $400 million allotted for comparative effectiveness research in the recently enacted American Recovery and Reinvestment Act.
The IOM divides the 100 comparative effectiveness research recommendations into four quartiles, with 25 recommendations in each quartile. The report also lists each of the four quartiles in descending order of importance. For example, in the first quartile, the report recommends research on the comparative effectiveness of care-coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease.
Another recommendation, this one in the fourth quartile, calls for comparing the effectiveness of coordinated, physician-led, interdisciplinary care provided in a patient's residence with usual care in managing advanced chronic disease in community-dwelling patients with significant functional impairments.
"This is an initial list only, and it is going to require sustained efforts to build on the work of this committee to provide (a) national research program with good ideas for studies to recommend and encourage," said Harold Sox, M.D., co-chair of the IOM committee that developed the recommendations, during a telephone news briefing on July 1.
Sox said one of the goals of comparative effectiveness research is to provide patients with the information they need to enter into discussions with physicians regarding their plan of care.
"Hopefully, armed with that information, more patients will feel they can speak up and really assert themselves in talking with their doctors to be sure their preferences are reflected in whatever treatment or testing is eventually decided on," said Sox.
The IOM divides the 100 comparative effectiveness research recommendations into four quartiles, with 25 recommendations in each quartile. The report also lists each of the four quartiles in descending order of importance. For example, in the first quartile, the report recommends research on the comparative effectiveness of care-coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease.
Another recommendation, this one in the fourth quartile, calls for comparing the effectiveness of coordinated, physician-led, interdisciplinary care provided in a patient's residence with usual care in managing advanced chronic disease in community-dwelling patients with significant functional impairments.
"This is an initial list only, and it is going to require sustained efforts to build on the work of this committee to provide (a) national research program with good ideas for studies to recommend and encourage," said Harold Sox, M.D., co-chair of the IOM committee that developed the recommendations, during a telephone news briefing on July 1.
Sox said one of the goals of comparative effectiveness research is to provide patients with the information they need to enter into discussions with physicians regarding their plan of care.
"Hopefully, armed with that information, more patients will feel they can speak up and really assert themselves in talking with their doctors to be sure their preferences are reflected in whatever treatment or testing is eventually decided on," said Sox.
Key Stakeholders
Sox pointed out that key stakeholders, including patients, physicians, professional organizations and insurers, heavily influenced identification of the 100 priority areas. Although the stakeholders nominated topics through an Internet-based questionnaire, the IOM used its own definition of comparative effectiveness research to determine whether submitted topics met the criteria for recommended topics. According to the IOM, comparative effectiveness research weighs the benefits and harms of various ways to prevent, diagnose, treat or monitor clinical conditions to determine which work best for particular types of patients and in different settings and circumstances.
The committee also applied other criteria to determine whether the topics submitted qualified for the list. That criteria included identifying gaps in evidence required for good decision making and the potential for research to actually change practice, according to Sox.
"The most frequently nominated and selected topic was actually methods to improve the delivery of evidence-based health care to patients," he said. "In other words, methods to improve the translation of research findings into actual patient care."
The second most identified topic involved health care disparities based on race and gender, said Sox.
The committee also applied other criteria to determine whether the topics submitted qualified for the list. That criteria included identifying gaps in evidence required for good decision making and the potential for research to actually change practice, according to Sox.
"The most frequently nominated and selected topic was actually methods to improve the delivery of evidence-based health care to patients," he said. "In other words, methods to improve the translation of research findings into actual patient care."
The second most identified topic involved health care disparities based on race and gender, said Sox.
More Recommendations
Several additional recommendations made by the IOM committee could have an effect on family physicians.
- The IOM report recommends that the federal government establish a national program to generate evidence to improve decision making by physicians and patients. The secretary of HHS would be required to establish a coordinating advisory body to help develop national strategies to organize, monitor, evaluate and report on the implementation and impact of any such comparative effectiveness research program.
- Patients, consumers and their caregivers should be involved in all aspects of the national comparative effectiveness research program, including planning, priority setting and the development of research proposals by individual researchers. These individuals also should be involved in evaluating decisions about funding proposals and dissemination of the results.
- The report also recommends developing large-scale clinical and administrative data networks to facilitate better use of daily data gathered on patient care, as well as development of better methods to make data available for researchers who want to study what happens daily in practices throughout the United States.
- More individuals should be trained in comparative effectiveness research methodology.
- The national comparative effectiveness research program should promote rapid adoption into practice of the findings of comparative effectiveness research and identify the most effective strategies for accomplishing that task.
