The American Recovery and Reinvestment Act (ARRA) of 2009 has dedicated $1.1B to bolster new comparative effectiveness research (CER), patient registries, infrastructure, and dissemination for a period of two years: $300M for Agency of Healthcare Research and Quality (AHRQ), $400M for National Institutes of Health (NIH), and $400M for the Department of Health and Human Services (DHHS). ARRA provided this money in an effort to understand how to better prevent, diagnose, and/or treat diseases throughout the country.
CER, an outcome based type of health care research, is used by investigators seeking to better understand the effectiveness of medical interventions and strategies for managing diseases. Researchers consider various patient related outcomes, like age and symptom relief, when comparing two or more approaches for managing a disease, and eventually parse out the most effective approach. CER investigators hope to improve individuals' health care outcomes by providing evidence that informs how doctors and patients make health-related decisions.
With CER at the forefront of public health research, there's a need to better understand academic health centers' capacity for conducting this kind of research and ways in which these institutions might use additional resources to further enhance their CRE research capabilities. The Clinical and Translational Science Award (CTSA) Consortium's Strategic Goal Committee Four recently published the results of their CTSA Comparative Effectiveness Research (CER) Capacity and Needs Assessment as a means of addressing these important issues.
The committee concluded that a wealth of broad and diverse CER activities, including clinical trials, inclusion of stakeholders, and use of practice-based research networks (among others), do indeed occur throughout the nation at the CTSA consortium level; however, institutions are not necessarily engaging in a spectrum of CER activities on an individual basis. The committee recommended further CER funding should build upon individual infrastructure and include more CER activities. They also recommended that CTSAs create explicit leadership roles for individuals performing internal and external communication and coordinating CER activities at each institution.
Similarly, even though CTSA institutions report having substantial amounts of CRE training resources, only a limited number actually offer comprehensive training in all areas of CER. As a result, the committee called for the addition of more comprehensive training modules representing a wider range of methods, and referred to this step as a top priority for advancing CER at the institutional and consortium levels.
Less than 50% of CTSA institutions surveyed reported even moderate use of their electronic medical record (ERMs) when conducting CRE research. This number seemed especially low since the committee concluded ERMs can be an important resource for supporting CER and enhancing local research capabilities.
"The CTSA Consortium can be an important player in Comparative Effectiveness Research," according to Jim Torner, PhD, Associate Director of Research Design, Interpretation and Informatics for the Institute for Clinical and Translational Science at the University of Iowa. He explained that the CTSA is similar in strength to a clinical trial network in that "The Consortium can provide the infrastructure to conduct multi-center research whether it is population-based, registry-based or clinical trials because of its contemporary diagnosis and treatment, expertise in clinical research, size, geographical distribution, and representativeness."
Principal investigators from 39 CTSA sites received the questionnaire designed to gather data about their academic health center's capacity for conducting CER, and responses were received from 33 sites. Download the questionnaire and report.
