A report released Tuesday by the Institute of Medicine recommends 100 health topics that should get priority attention and funding from a new national research effort to identify which healthcare services work best.
It also spells out actions and resources needed to ensure that this comparative effectiveness research initiative will be sustained, with a process for updating priorities as needed, and that the results are put into clinical practice.
A committee convened by the IOM developed the list at the request of Congress as part of a $1.1 billion effort to improve the quality and efficiency of healthcare through comparative effectiveness research, outlined in the American Recovery and Reinvestment Act of 2009.
The committee's report provides independent guidance – informed by public input – to Congress and the Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care.
Health experts and policymakers anticipate that comparative effectiveness research will yield greater value from America's healthcare system and better outcomes for patients. Despite spending more on care than any other industrialized nation – $2.4 trillion in 2008 – the United States lags behind other countries on many measures of health, such as infant mortality and chronic disease burden.
According to the IOM, comparative effectiveness research weighs the benefits and harms of various ways to prevent, diagnose, treat and monitor clinical conditions to determine which work best for particular types of patients and in different settings and circumstances. Study results can help consumers, clinicians, policymakers and purchasers make more informed decisions, ultimately improving care for individuals and groups.
"Healthcare decisions too often are a matter of guesswork because we lack good evidence to inform them," said committee Co-chairman Harold Sox, editor of the Annals of Internal Medicine. "For example, we spend a great deal on diagnostic tests for coronary heart disease in this country, but we lack sufficient evidence to determine which test is best."
Co-chairman Sheldon Greenfield, professor of medicine and executive director at the Health Policy Research Institute at the University of California, Irvine, said the report lays the foundation for helping providers make better decisions and achieve better results. "To make the most of this enterprise, HHS will need to ensure that the results are translated into practice and that the public is involved in priority setting to ensure that the research is relevant to everyday healthcare," he said.
The priority areas reflect the insights of health professionals, consumer advocates, policy analysts and others who submitted nominations online. The committee received 1,268 unique topic suggestions, which it narrowed to 100 based on a set of criteria that included its charge to develop a balanced portfolio.
According to the IOM, the list reflects a range of clinical categories, populations to be studied, categories of interventions and research methodologies. The committee developed its list of priorities independent from the comparative effectiveness research activities that other organizations have been charged to do through the American Recovery and Reinvestment Act.
The committee underscored the importance of having patients, families and caregivers actively engaged in identifying research topics of most concern to them.
The committee also warned that comparative effectiveness research will fall short of its potential without vigorous efforts by the HHS to promote adoption of the findings by healthcare providers and organizations.