Comparative effectiveness research has received significant public attention since the federal government designated $1.1 billion in funding toward it in the 2009 economic stimulus bill. Even more recently, the research received a boost in the federal health reform law with establishment of the Patient Centered Outcomes Research Institute.
Broadly defined, comparative effectiveness research aims to determine the benefits and harms of different health-care treatment options — including drugs, medical devices and surgeries. New technologies emerge every day in health care, but how effective and efficient are these advances for patients, and the health-care system?
That’s the question researchers at the UW are tackling to help patients get the most appropriate and effective treatment for an illness or injury. In searching for efficiencies, scientists also hope to help individuals and the health system save money by minimizing the use of expensive, ineffective treatments. “Comparative effectiveness research helps health-care providers and patients determine what can help achieve the best outcomes,” said Dr. Larry Kessler, UW professor of health services.
The UW has housed some of the nation’s foremost scientists in comparative effectiveness research for years. Until recently, these researchers were largely working independently in individual units and centers across campus. But that all changed in November 2009, when several centers came together to form the UW Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance.
The founding members of the Alliance have expertise in health services research, health policy and economics, technology assessment, patient-reported outcomes and health systems evaluation, among others. Founding members include:
- Biobehavioral Nursing and Health Systems, School of Nursing
- Comparative Effectiveness, Cost and Outcomes Center, Schools of Medicine and Public Health
- Department of Health Services, School of Public Health
- Harborview Injury Prevention and Research Center, Schools of Medicine and Public Health
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy
- Seattle Quality of Life Group, School of Public Health
- Surgical Outcomes Research Center, School of Medicine
- Veterans Affairs Health Services Research & Development Center, VA Puget Sound Health Care System
Alliance member groups to date have received two major cross-collaborative grants (cancer diagnostics, bariatric surgery outcomes) and three new training grants. In June 2010, the group also held its first major symposium on using the findings from comparative effectiveness research to inform clinical and reimbursement decisions.
Cancer diagnostics include magnetic resonance imaging (MRI), CT (computed tomography) and PET (positron emission tomography) scans.
“The evidence base for diagnostics is currently very poor,” said Kessler, in discussing the cancer genomics project. “We often expose patients unnecessarily to radiation, which creates anxiety and may not result in the best outcome.”
Alliance leaders said they hope to implement an almost immediate application of research results. “It doesn’t do you any good if it sits on the shelf,” said Kessler. “It has to change medicine and public health practice.”
Kessler and Sean Sullivan, UW professor of pharmacy and health services, are co-investigators of a $4 million Alliance project that is part of a larger $16 million project that includes researchers from the Fred Hutchinson Cancer Research Center, Group Health Cooperative, Premera Blue Cross, Regence Blue Shield and others. Kessler and Sullivan will work with colleagues from UW Medicine, the VA Puget Sound Health Care System and the Puget Sound Health Alliance on the project.
Additional Alliance grants received will support career development training for health sciences faculty in community-based settings including the Washington State Health Care Authority, Premera Blue Cross and Group Health Cooperative — and in pediatric injury research.
Post-doctoral surgeons will also have the opportunity to beef up research skills with a focus on outcomes, thanks to an additional grant. “Surgery is a discipline that has historically lagged behind in funding researchers,” said Dr. David Flum, UW professor of surgery and adjunct professor in the School of Public Health. “Surgeons have only comprised two to three percent of total National Institutes of Health funding over the last 20 years,” he said.
The timing to establish the Alliance meshes well with national health-care reform, too. “Regardless of what you believe politically, our current system is not sustainable,” said Sullivan. “Comparative effectiveness research is a means of addressing failures in the health-care system that can better inform clinical and reimbursement decisions. It can measure what is and isn’t working in treatment options.”
For more details on the Alliance, including descriptions of funding and grants received to date, and upcoming events, visit the group’s web site.