The Bipartisan Policy Center’s (BPC) https://bipartisanpolicy.org April 18th event discussed the importance of Comparative Effectiveness Research (CER) and how CER can help doctors and patients choose the best possible options for medical treatments.
Jodi Segel M.D, Co-Director, Center for Drug Safety and Effectiveness, Professor of Medicine, Johns Hopkins University, School of Medicine www.hopkinsmedicine.org/som, stressed how CER can help get the right treatment to the right patient at the right time.
As Dr. Segel said, “This goal can be accomplished if both the medical profession and patients work together to make informed decisions on how to treat an illness or condition. This can be done by comparing drugs, tests, and surgeries for the delivery of healthcare.”
She pointed out that most research in general produces very little scientific evidence, resulting in care delivery being uneven, and not always benefiting patients or the whole population. She wants to see CER provide the necessary answers to clinical questions in order to upgrade the value of care.
The bulk of the funding for this type of research is provided by the Agency for Health Research and Quality (AHRQ) www.ahrq.gov. AHRQ is producing the evidence to make healthcare safer and the ability to attain higher quality more accessible and affordable care.
Panelists followed Dr. Segel’s talk with Gail Wilensky PhD, Economist, Senior Fellow, Project HOPE www.projecthope.org moderating the panel discussion. Jan Hyde, Heart Valve Patient Ambassador for the American Heart Association discussed her own experiences making decisions related to her health. She was born with a congenital heart defect requiring two open-heart surgeries by the time she was 25.
She talked about making decisions when faced with three options as to the different types of valves the doctors recommended that could be surgically implanted. She feels fortunate that she was able to talk to her doctors at a private research institution in Manhattan and could with her doctor’s advice choose the right valve for her medical condition. However, she wishes the same care was available all over the U.S especially in rural communities.
Joe Selby MD, Executive Director for the Patient-Centered Outcomes Research Institute (PCORI) www.pcori.org told the attendees “PCORI was established to fund research to help patients and caregivers make better informed decisions about the healthcare choices they face every day.
PCORI has been studying how to effectively use antibiotics for children with bone infections, studying the common approach to prescribing a daily dose of aspirin to prevent heart attacks and strokes, studying the problem of how to determine the dose of each medicine to effectively treat patients, and studying ways to measure pain and depression.
All agree that the issue affecting clinicians and patients is the need to find the best possible way to disseminate information to patients and clinicians. As Dr. Selby emphasized, “There is no simple way.” This year, PCORI has actively reported on results from CER studies with articles published in journals, research articles available for free, plus research results are posted on the website. “However, there is still the need to move the information into practice at a faster rate into the practice of medicine.”
Carolyn Clancy, MD Deputy Under Secretary for Health for Organizational Excellence at the Veterans Health Administration, (VHA) www.va.gov/health told the attendees, “The VA has a strong commitment and interest in CER. The VA’s goal is to understand what treatments work and under what circumstances treatments should be used, and for how long. So far, the literature is pretty silent and leaves the real decisions up to patients.”
She adds. “VA’s research portfolio has had success determining the right medications to give each patient and how to collect data to use for other studies. However, more research needs to be done on chronic pain, mental health, and then follow up with longitudinal studies.”
The VA works with NIH and medical schools to offer resources and new information. A most successful program at the VA called “The Million Veterans” program www.research.va.gov links treatments with genomic profiles which helps determine the right treatment for each patient.
Lastly, addressing the needs of a large private integrated healthcare delivery and financing organization, Murray Ross, PhD, Vice President Kaiser Foundation Health Plan, and Director of the Kaiser Permanente Institute for Health Policy www.kpihp.org, reports “Kaiser takes care of 11 million people but we still feels responsible for patients one at a time. The question always asked, Why when treating a large population are some patients doing better than others? To find the answer, it is necessary to think outside the box.”
To achieve understanding of how to develop an integrated system, Kaiser produces customized policy reports, connects healthcare experts, advisers, policymakers, and providers through national and international networks, provides publications, and conducts conferences.
Go to https://www.c-apan.org/video/?427128-1/bipartisan-policy-center-hosts-discussion-patient-treatment-options to view the video on C-Span 2.