Creating a New Structure for Research on Health Care Effectiveness

Abstract

Effectiveness research (a term we use in preference to the more confining and difficult health services or outcomes research) evaluates the clinical setting and the health care system on which it depends. It uses a variety of health care assessment techniques and the practical clinical trial to inform clinical practice, quality interventions, and health policy decisions. Effectiveness research had not had sufficient public or private funding to produce the information needed to facilitate evidence-based health care improvement. However, recent trends, such as the likelihood for continued substantial increases in health care costs and concern regarding the quality and safety of the US health care system, are among the important arguments for increasing its funding and capacity. We propose a new entity, a public-private consortium to expand and offer new capability and resources in this area. The consortium would consist of all relevant public and private entities. It would be organized into an executive committee, which would identify research priorities and panels to design requests for proposals. Competitive peer-reviewed proposals, transparency and balance of forces in choice of topics, conduct of research, and interpretation of results would be important features. Metrics for success would be use of the data derived from consortium projects in medical decision making and benefit design. The consortium would provide balance and potential mediation of conflicting or competing interests in which all stakeholders will be present to establish the rules. Broad representation of all interests would serve to avoid the economic, policy, and political issues that have bedeviled past efforts. Models for the consortium include the Health Effectiveness Institute, the Centers for Education and Research on Therapeutics, and the Transportation Research Board.

Challenges Facing the US Patient-Centered Outcomes Research Institute

“…5 The model identified by the CRR is similar to the long-standing cooperative research programs of the National Academies' Transportation Research Board.…”

Deriving effectiveness information for decision-making

“…Effectiveness research (a term we use in preference to the more confining and difficult health services or outcomes research) evaluates the clinical setting and the healthcare system on which it depends. It uses a variety of healthcare assessment techniques and practical clinical trials to inform clinical practice, quality interventions and health policy decisions [6]. Effectiveness research rectifies many of the problems of RCT data, albeit with its own shortcomings.…”

Leadership for health care in the 21st Century: A personal perspective

“…Genomics, postgenomics and the dividends from the transcriptome, proteome, metabolome, and the microbiome, with accompanying bioinformatics, information technology, and imaging, are shaping health care in the 21st Century. [9][10][11]20 In tandem, remarkable health disparities based upon socioeconomic determinants have also been illuminated. These "drivers" add additional complexity for leadership in biomedical science and technology.…”

“…[9][10][11] One exemplar for the need of transformational leadership and recommendations can be found in the IOM report "Academic health centers: leading change in the 21st Century". 11 The meaning of "transformational" leadership through my prism is a form and style of leadership that literally provides "positive" changes in followers, enhancements or radical changes of infrastructure processes, and significantly increases performance and measurable outcomes.…”