Charles P. Clayton
In its initial report released June 30, 2009, the Federal Coordinating Council for Comparative Effectiveness Research identified seven gaps in the nation’s current comparative effectiveness research (CER) efforts, including a lack of coordination across funding agencies, the relative paucity of CER to date, and underinvestment in human capital. The panel called for investments in data infrastructure, dissemination and translation of CER, conduct of additional research in priority populations, and performance of research on non-pharmacologic therapies. The Institute of Medicine (IOM) also released a CER report June 30, which outlined 100 clinical areas for CER studies as well as other recommendations.
Both panels were created as a result of the passage of the American Recovery and Reinvestment Act (PL 111-5), which designated $1.1 billion for CER to be spent over the next two years. The funds were allocated to the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Secretary of Health and Human Services. Leaders of those agencies are to submit a plan for expending the CER funds by July 30, 2009, as well as an update on funded projects by November 1, 2009.
The coordinating council reached its conclusions after inventorying federal, state, and private CER efforts. The conclusion to primarily focus on data infrastructure rested on the panel's prioritization criteria, including potential for impact and the need to fill gaps in current knowledge. "Data infrastructure," the panel stated, "could include linking current data sources to enable answering CER questions, development of distributed electronic data networks and patient registries, and partnerships with the private sector." Unstated by the council was the potential for data infrastructure to support a long-term national effort in CER.
The IOM report explicitly addressed the need for a national CER program "to sustain CER well into the future." To this end, the committee went beyond a delineation of potential projects to recommend ways to coordinate, monitor, and report on future CER efforts. The report did not explicitly recommend the assignment of these roles to a particular federal agency or future federal funding levels for CER.
Among topics the IOM panel included in the first quartile for funding were:
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Treatment strategies for atrial fibrillation including surgery, catheter ablation, and pharmacologic treatment.
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Primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk.
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Strategies for reducing health care associated infections.
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Strategies for introducting biologics into the treatment algorithm for inflammatory diseases.
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Care coordination programs, including the medical home, in managing chronic diseases in adults and children.
Departments of internal medicine should be attentive to these reports and future developments in CER, as it will likely develop into an ongoing field of federal investment in medical research.