Impact of CER on Healthcare Decision Making Yet to Be Realized, NPC Finds

Comparative effectiveness research (CER) is not new, but its importance to decision making in the healthcare realm has increased greatly since passage of the Affordable Care Act (ACA).

The ACA established the Patient-Centered Outcomes Research Institute (PCORI) and provides federal support for the CER. Those who purchase healthcare, whether they are private or public payers, employers, or benefits managers, will be increasingly dependent on the results of CER to help determine how they decide to spend on healthcare benefits.

The National Pharmaceutical Council (NPC) sponsored 5 annual surveys of healthcare decision makers affected by CER to better understand the adoption and implementation of CER and how it affects healthcare decision makers. A new study in the February 2016 issue of Journal of Comparative Effectiveness Research by Kimberly D. Westrich, MA, of NPC, and colleagues investigates the results of those surveys. Using the Institute of Medicine definition of CER (“The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care”), each round of the survey asked respondents how much impact they felt CER has had or will have in the future.

Analysis of the surveys shows that belief in the importance of CER is largely solid, but its impact is yet to be realized or acknowledged by stakeholders in the United States. Its impact on medical decision making “remains a moving target that is at least 5 years in the future despite the rapid increase in CER activity over the past several years,” the study stated. The results of efforts to promote CER and funding and conducting research are still mostly to be realized, and there is little coordination of evaluation and interpretation of the results of CER.

Few stakeholders see significant impact of CER in the short term, the NPC-sponsored study concludes, and new efforts concerning CER would benefit from improved plans for translating the eventual findings into information that is readily available, addresses real-world questions, and can be applied to medical decisions that are relevant to specific populations and the situations in which decision makers must operate. Stakeholders note the growing significance of the PCORI’s role in establishing research standards and funding and monitoring CER, and they expect the Agency for Healthcare Research and Quality to have a leading role in translating and disseminating research.

The study concludes that there is fertile ground for coordinated and sustained efforts to translate the results of new CER that satisfied the methodological criteria for high-quality research. But stakeholders will realize greater impact from CER only if new efforts provide information that is readily available and can be applied within their healthcare systems to real-world decisions in specific patient populations.