Recently, a National Public Radio commentator described comparative effectiveness research (CER) as “a fancy way of referring to research that tries to figure out which of the treatments we use now actually work.” Despite the “fancy” label, CER is seen by many in health policy as pragmatic way to reduce healthcare costs while improving patient care.
At ATS 2011, attendees will have several opportunities to learn about CER.
Kristin A. Riekert, PhD
The symposium A9 “The Science of Disseminating and Implementing Interventions: Efficacy Versus Effectiveness Research,” which will take place from 8:15 to 10:45 a.m. on Sunday May 15, will focus on behavioral and educational interventions, according to symposium co-chair Kristin A. Riekert, PhD.
“Effectiveness and dissemination studies are rarely conducted, despite the fact that there are many challenges in translating effective therapies from controlled research settings into clinical practice,” said Dr. Riekert, who is assistant professor and co-chair of Johns Hopkins Adherence Research Center in Baltimore.
The symposium aims to bridge the gap between research and practice by presenting RE-AIM (reach, efficacy/effectiveness, adoption, implementation and maintenance), a conceptual framework for designing and evaluating clinical studies. The developer of RE-AIM, Russell E. Glasgow, PhD, will speak on the subject during the session.
“The RE-AIM model is a terrific way to evaluate the potential public health impact of an intervention.” Dr. Riekert said. “It highlights the fact that a good intervention can’t just work in a controlled research setting—it matters whether the targeted population gets the intervention delivered as intended in real-world clinical practice.”
The symposium will then present several efficacious interventions that have been successfully translated to broader populations in areas such as asthma, cystic fibrosis and secondhand smoke reduction. Dr. Riekert said she expects lively discussions that will make the audience think about how they design studies and engage in clinical practice.
Dr. Riekert will be joined by co-chairs Jean-Marie Bruzzese, PhD, of New York University Child Study Center, and Lynn Gerald, PhD, MSPH, of the University of Arizona in Tucson.
CER and Nursing Research
According to Sandra K. Hanneman, PhD, RN, FAAN, CER has been around for 40 years, “but it recently has been thrust into the public spotlight by the economic downturn and healthcare reform,” said Dr. Hanneman, associate dean and research professor at the Center for Nursing Research at the University of Texas in Houston.
Sandra K. Hanneman, PhD, RN, FAAN
“After decades of emphasis on the randomized controlled trial (RCT) as the gold standard for rigorous clinical research, it may be a challenge for researchers to embrace the distinctions between RCTs and CER,” she said. Dr. Hanneman will present the challenges in her talk, “Comparative Effectiveness Research in Nursing,” at 2 p.m. on Monday May 16, as part of the B81 “Nursing Year in Review.”
Dr. Hanneman said the session would help practitioners learn the differences between RCT and CER questions and methods, how they can use the results of CER and how they can keep up in “today’s accelerated CER movement.” For her talk, Dr. Hanneman will review CER papers spanning pulmonary and critical care medicine.
“Compared with other types of research, CER places a greater focus on the burden of illness, evidence of misuse (either underuse or overuse), cost of the treatment, how controversial the treatment options are, the potential to reduce health disparities, and healthcare delivery strategies,” Dr. Hanneman said. “I hope that attendees will be assured that good science and good practice are good for patients with pulmonary, critical care and sleep disorders regardless of the research framework du jour.”
CER & COPD
CER will be the topic of session L2 “COPD Outcomes-Based Network for Clinical Effectiveness and Research Translation (CONCERT),” from noon to 1 p.m. on Sunday, May 15. The session will discuss the CONCERT consortium and COPD comparative effectiveness research; developing research agendas for CER; and developing linked registries for observational CER studies as a basis for pragmatic clinical trials of effectiveness.
CER Now
The scientific symposium C5 “Comparative Effectiveness Research: Why Now?” which will take place from 8:15 to 10:45 a.m. on Tuesday, May 17, will describe the current need for CER in asthma, critical care, sleep disorders and COPD. The symposium is a follow-up to the ATS 2010 Presidential Symposium on the subject.
“The NIH and Agency for Healthcare Research and Quality are very interested in comparative effectiveness research as are key stakeholders such as insurance companies and our patients” said Dr. Riekert, who will also co-chair this symposium.
“This course is intended to describe how a CER study might be designed for pulmonary, critical care and sleep research, including appropriate populations, interventions, outcomes and likely challenges to be faced,” she said. Such help is needed because most researchers have been taught to design efficacy studies rather than effectiveness studies when designing interventional trials, Dr. Riekert said.
“I hope attendees walk away from this session with a better idea of how to conduct CER and why this research complements, not competes with efficacy trials,” she said.
Chris Goss, MD, MSc, assistant professor of medicine at the University of Washington Medical Center in Seattle, and James P. Kiley, PhD, MS, director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute, will co-chair the symposium.