Summary of the Institute of Medicine’s Comparative Effectiveness Research Priorities Report

As part of the American Recovery and Reinvestment Act of 2009 (also known as the stimulus package), $1.1 billion was allocated to comparative effectiveness research (CER). The Secretary of Health and Human Services (HHS) was also required to enter into contracts with the Institute of Medicine (IOM) to recommend CER priority projects to be conducted or supported by stimulus funds. On Tuesday, June 30, IOM released its report, “Initial National Priorities for Comparative Effectiveness Research.” View IOM summary (PDF,488K)

In order to complete the project, IOM established the “IOM Committee on Comparative Effectiveness Research Prioritization” (referred as the Committee). The Committee was tasked with three objectives:

• Establish a working definition of CER
• Develop a national priority list of research projects using stakeholders’ input
• Identify the necessary requirements to support a robust and sustainable CER enterprise

Definition of CER

The IOM defines CER as:

“...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. The purpose of CER is to assist consumers, clinicians, purchasers and policy makers to make informed decisions that will improve health care at both the individual and population levels.”

National Priority List

As a first step, the Committee sought stakeholders’ input through public hearings, web-based questionnaires, direct mail, and e-mail solictition. To assess the importance of the topics proposed by the stakeholders, the Committee developed a set criteria including condition-level criteria (e.g., burden of disease, cost and variability), and priority topic-level criteria (e.g., gap in existing knowledge, likelihood that the results will improve human health).

The initial 100 priority topics include research projects on disorders by organ system, specific population, and systems of care. The Committee listed the topics by quartile (groups of 25). The first quartile is considered the highest priority group and the fourth quartile the lowest. Within each group, however, the order of individual topics does not indicate rank. Among the priorities identified by the Committee:

• Compare the effectiveness of treatment strategies for atrial fibrillation including surgery, catheter ablation, and pharmacologic treatment (1st quartile)
• Compare the effectiveness of comprehensive care coordination programs, such as the medical home (an evolving model of care incorporates expanded access and communication, improved coordination and
  integration of care, changes in administrative processes and quality oversight, active patient and family involvement, and linkages with community-based services), and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities (1st quartile)
• Compare the effectiveness (including resource utilization, workforce needs, net health care expenditures, and requirements for large-scale deployment) of new remote patient monitoring and management technologies (e.g., telemedicine, Internet, remote sensing) and usual care in managing chronic disease, especially in rural settings (2nd quartile)
• Compare the effectiveness of accountable care systems and usual care on costs, processes of care, and outcomes for geographically defined populations of patients with one or more chronic diseases (2nd quartile)
• Compare the effectiveness of innovative treatment strategies (e.g., cardiac resynchronization, remote physiologic monitoring, pharmacologic treatment, novel agents such as CRF-2 receptors) for congestive heart failure (3rd quartile)
• Compare the effectiveness of alternative redesign strategies—using decision support capabilities, electronic health records, and personal health records—for increasing health professionals’ compliance with evidence-based guidelines and patients’ adherence to guideline-based regimens for chronic disease care (3rd quartile)
• Compare the effectiveness of different benefit design, utilization management, and cost-sharing strategies in improving health care access and quality in patients with chronic diseases (e.g., cancer, diabetes, heart disease) (3rd quartile)

View the 100 initial priority topics (PDF, 36K) 

Recommendations for a Robust CER enterprise

According to the Committee, a sustainable national CER program will need the following:

• Continuous evaluation of research priority topics
• Coordination of private and public strategies
• Periodic reports outlining research progress
• Involvement of consumers, patients, caregivers, and health care providers in all aspects of CER to ensure its relevance to everyday health care delivery
• Large-scale clinical and administrative data networks that enable observational studies of patient care while protecting patient privacy and data security
• Effective strategies to disseminate CER findings and promote their adoption by clinical practices

For more information, please visit the IOM CER Prioritization website.