Outcomes Research:The Good, the Bad & the

Ugly

Michael Hager, EMS-RN, BSNMSNV 600

Dr. Catie Chung, PhD, RN, CNE, CCM, WCC

The Good

“Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make informed health care decisions, allowing their voices to be heard in assessing the value of health care options” (Patient Centered Outcomes Research Institute, 2012, p.1).

The quality and pertinence of evidence regarding the effectiveness of health-care services is essential to policy questions related to clinical care, reimbursement, and, ultimately, public health.

The Good

Comparative Effectiveness Research (CER) Patient Protection and Affordable Care Act (PPACA) anticipates

the implementation of CER as a matter of prescribed federal policy and practice (Thorpe, 2010).

CER raises important issues for public health The Institute of Medicine (IOM), whose study of CER was highly

influential in creating the CER provisions in health reform, defines CER as the study of methods, including alternative approaches, to “prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care” and inform decision-making by “consumers, clinicians, purchasers, and policy makers (Thorpe, 2010).

The Bad

The IOM definition is extremely broad and potentially encompasses not only head-to-head comparisons of different clinical treatments, but also approaches that use community- and population-level interventions to affect clinical conditions (Thorpe, 2010).

The use of cost information in CER is one of the most controversial issues.

Supporters argue that without cost information, the utility of CER to inform clinicians, patients, and payers about the cost-benefit of various treatments will be limited. Opponents fear that the use of cost information will limit access to care and limit the development of new and innovative health-care technologies (Thorpe, 2010).

The Bad

The IOM definition is extremely broad and potentially encompasses not only one-on-one comparisons of different clinical treatments, but also approaches that use community- and population-level interventions to affect clinical conditions.

Challengers of a national policy to advance CER raise concerns regarding its potential to limit access and stymie variation and innovation in health care to the harm of individuals with rare conditions or those whose complex health conditions and/or social risks place treatment outside clinical standards. (Thorpe, 2010).

The (not so) Ugly

Whether narrowly or broadly defined, CER and the evidence it generates can play a pivotal role for clinicians, patients, payers, health professionals, and policy makers.

The American Recovery and Reinvestment Act of 2009 (ARRA)4 and the PPACA5 meaningfully move the nation toward a national CER policy (Thorpe, 2010).

Conclusion

Principal all of these issues will be the point to which the public health policy is realized in a manner that restricts the scope of research to medical interventions or, instead, in a manner that promotes population health interventions that direct the prevention, mitigation, or treatment of chronic conditions among the public.

References

Patient Centered Outcomes Research Institute. (2012). Patient-Centered Outcomes Research Definition Revision:

Response to Public Input. Retrieved from http://www.pcori.org/assets/PCOR-Definition-Revised-Draft-and-Responses-to-Input.pdf

Thorpe, J. H. (2010). Comparative effectiveness research and health reform: implications for public health policy and

practice. Public Health Reports (Washington, D.C.: 1974), 125(6), 909-912.