JUNE 21, 2012

Welcome to the Comparative Effectiveness Update eNewsletter
This issue is sponsored by the Quality Colloquium

PCORI Announces Pilot Projects Program Awards Recipients, Research Topics
The Patient-Centered Outcomes Research Institute (PCORI) announced approval of 50 funding awards totaling $30 million over two years. Joe Selby, MD, MPH, the Institute's Executive Director, said, "These projects will improve our understanding of how to conduct research and disseminate research findings in ways that are more responsive to the needs of patients and the health care community." Awardees and project descriptions can be found at: http://www.pcori.org/funding-opportunities/pilot-projects/funded/. (PCORI, June 18, 2012)

CER Study Finds No Observable Difference between Generic and Branded Statins in Preventing Cardiovascular Events
Research by WellPoint, a health benefits company, found no difference in the lowering of the rate of cardiovascular events between patients using branded statins versus those using generic statins. The use of branded statins represents an increase of 30% in costs over generics. (MarketWatch, June 4, 2012)

SNMMI: Cool Pics Don't Cut It -- Why Imaging Needs Comparative Effectiveness Studies
Rory Hachamovitch, MD, of the Cleveland Clinic, said that the generation of "cool pictures" is not enough for referring physicians. He pointed out in his presentation at the annual meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) meeting that "...imaging doesn't alter patient outcomes. It alters physician management, which alters treatment, which impacts outcomes." The inherent vagary makes comparative effectiveness research difficult because imaging's value cannot be directly assessed. His conclusion: "Comparative effectiveness research is a huge opportunity for us to show what our field can offer." (Cardiovascular Business, June 11, 2012)

CER: Friend or Foe?
Comparative effectiveness research (CER) has been maligned by many as a prelude to rationing, increasing bureaucracy, and restrictive controls at every turn. This article makes the case for CER. Rather than serving as a simple cookie cutter of care, CER is designed at the outset, the author argues, "...to be relevant to specific subsets of patients in actual clinical settings." (The Hospitalist, June 2012)

The Mysterious Diagnosis: A Reflection on Comparative Effectiveness
This is an interesting Health Affairs blog post by Michael Halpern, MD, PhD, a physician and researcher, recounting an interaction with a specialist he had recently. His symptoms for a condition he'd had for many years flared up and his regular specialist, after reviewing equivocal test results, made a diagnosis. Upon further research by the author/patient, he disagreed and his physician who responded that his experience led him to be able to sense who had this particular condition in spite of objective facts. This interaction caused the author to conclude that a physician's subjective sense may be more likely to produce a "cookie cutter" response than the results from comparative effectiveness research. (Health Affairs Blog, June 7, 2102)

Study Examines Comparative Effectiveness of Rhythm Control vs. Rate Control Drug Treatment
An observational study reported little four year mortality differences in atrial fibrillation (rapid, irregular heart beat) patients being treated pharmaceutically for rhythm control versus rate control. The researchers, from Harvard School of Public Health, noted that they observed but have not fully researched, "... a tendency toward a long-term protective effect for rhythm control drugs." (Online First by Archives of Internal Medicine, June 4, 2012)

Preliminary Draft Methodology Report: "Our Questions, Our Decisions: Standards for Patient-Centered Outcomes Research"
The Patient-Centered Outcomes Research Institute (PCORI) published for public comment on June 4, 2012 the preliminary draft of its "Methodology Report." This report contains guidelines and includes 60 standards for conducting comparative effectiveness research. (PCORI, June 4, 2012)

The Trouble with 'Doctor Knows Best'
In this New York Times item, Peter B. Bach, MD, a former senior adviser at the Centers for Medicare and Medicaid Services from 2005 to 2006 and currently the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center in New York, makes the case for a more studied approach to healthcare by binging into focus the issues surrounding screening, particularly cancer screening and the need for solid, research supported facts. He notes that the majority of cervical cancer patients today are women who have inadequate Pap smear testing. "And despite the apparent move toward evidence-based medicine and comparative effectiveness research," he says, "most of us still feel that our own experiences and insights are the most relevant factors in medical decision-making." (New York Times, June 4, 2012)

Summary of AHRQ's Comparative Effectiveness Review of Drug Therapy for Rheumatoid Arthritis in Adults

This monograph from the Agency for Healthcare Research and Quality (AHRQ) presents an activity for CME/CE credit on the subject of reviewing the effectiveness of rheumatoid arthritis drugs.

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Practice-Based Evidence Study Design for Comparative Effectiveness Research

Susan D. Horn, PhD
Institute for Clinical Outcomes Research, Salt Lake City, UT