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J Scott Parrott

National Institute for Health Care Reform | Publications - 0 views

www.nihcr.org/ve-Effectiveness-Research.html

shared by J Scott Parrott on 16 Dec 10 - No Cached
  • Comparative Effectiveness Research and Innovation: Policy Options to Foster Medical Advances
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      article from NIHCR on CER
  • Patient Protection and Affordable Care Act (PPACA),1 creates a formal structure to guide publicly financed CER going forward
  • The law creates a private, nonprofit corporation—the Patient-Centered Outcomes Research Institute (PCORI)
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      Patient Protection and Affordable Care Act (PPACA)
  • ...4 more annotations...
  • comparing one treatment approach
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      CER focuses on treatment, is screening or assessment involved?
  • Lastly, some stakeholders have expressed concerns that increased use of CER to inform clinical decisions could cause harm by holding innovative therapies to an inappropriate or onerous standard of effectiveness and discouraging their development and diffusion.
  • With the PPACA’s enactment, many decisions already have been made to minimize risks to innovation from comparative effectiveness research. For example, the law explicitly bars the PCORI from mandating coverage, reimbursement or other policies for any public or private payer.
  • Patient Protection and Affordable Care Act (Public Law No. 111-148), Section 6301.
J Scott Parrott

Five Next Steps for a New National Program for Comparative-Effectiveness Research | Hea... - 0 views

healthpolicyandreform.nejm.org/?p=3017

shared by J Scott Parrott on 16 Dec 10 - No Cached
  • Five Next Steps for a New National Program for Comparative-Effectiveness Research
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      Overview of CER in NEJM Perspectives
  • The IOM made 10 recommendations for its development (see Institute of Medicine’s Recommendations for a National System of Comparative-Effectiveness Research)
  • Regardless of the specific outcome of the health care reform effort, CER will probably account for an increasing portion of the U.S. research enterprise
  • ...9 more annotations...
  • Second, the CER program should establish an initial list of priority topics and evaluate the current state of knowledge about each.
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      Although, by the time the state of current knowledge has been evaluated, the priorities are likely to have changed.
  • First, the national CER program must develop an overall funding strategy.
  • Deciding which research questions to address first is complex, because the priority topics vary widely in their potential impact on health care costs and outcomes, target population, and the most suitable research methods and their costs. We propose a five-step process.
  • Third, the CER program, with the help of expert advisory committees and the research community, should choose the research methods that will fill gaps in the evidence for a specific topic.
  • Defining the desired future state — a desired patient care outcome, reduced harms, or a change in clinical practice — is a key step in defining research objectives and refining the research question, which in turn drive the choice of methods and the projected research costs
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      Define the desired future state. Would this work differently for screening or assessment versus intervention? We may find better ways to identify problems, but if the interventions are not effective, it's not clear this would make a difference.
  • Modeling potential population-level effects can help the CER program to decide which research questions to fund. Modelers will need to estimate the likelihood of various study results, implementation strategies, and possible shifts in practice and policy
    • J Scott Parrott
      J Scott Parrott on 16 Dec 10
       
      Modeling population level effects can improve CER
  • This conceptualization of policymaking means that the end users of research results must identify their requirements for certainty in decision making and communicate them to the CER program as input into the design of a research portfolio
  • Fourth, the program should strive for a balanced portfolio of high-impact research topics.
  • Fifth, the CER program should evaluate progress and report to the public.
J Scott Parrott

Charting a Path From Comparative Effectiveness Funding to Improved Patient-Centered Hea... - 0 views

jama.ama-assn.org/...985.full

shared by J Scott Parrott on 16 Dec 10 - No Cached
  • Charting a Path From Comparative Effectiveness Funding to Improved Patient-Centered Health Care
  • In addition, the best methods of delivering this information at the point of care must be determined to integrate the information into the normal workflow and decision processes of clinicians and patients
J Scott Parrott

Possible Outcomes of Comparative Effectiveness Research, July 8, 2009, Brook 302 (2): 1... - 0 views

jama.ama-assn.org/...194.full

shared by J Scott Parrott on 16 Dec 10 - No Cached
  • Possible Outcomes of Comparative Effectiveness Research
  • Discussions to date suggest that most of the funds will be spent comparing one clinical procedure, device, or drug with another
  • The comparative effectiveness funds should be allocated according to a framework designed to identify procedures, devices, and drugs that would reduce cost but not diminish health.
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  • So a second requirement for work funded under the stimulus package should be that successful innovations are implemented immediately
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