Right Care, Right Patient, Right Time: The Role of Comparative Effectiveness Research

 

Panelists for this briefing included: Alfiee M. Breland-Noble, Ph.D., MHSc, Project Director, African American Knowledge Optimized for Mindfully-Healthy Adolescents (AAKOMA), Center for Trauma and the Community, Georgetown Medical Center (“Dr. Alfiee”), John Bulger, D.O., MBA, Chief Medical Officer, Geisinger Health Plan, Eleanor Perfetto, M.S., Ph.D., Senior Vice President, Strategic Initiatives, National Health Council, Sean Tunis, M.D., M.Sc., Founder and Senior Strategic Advisor, Center for Medical Technology Policy, and Gail R. Wilensky, Ph.D., Senior Fellow, Project HOPE.

 

The briefing opened with the panelists discussing how important it is to use evidence to improve care. The evidence needs not only to tell which treatment works best, but what works best for which patients. Having patients involved as partners in the research is important to achieving that. Patients need to be involved as study participants or through the data collection but need to be collaborating with researchers from the design of the study all the way through analysis of the results. Treatments and tests are rarely, if ever, “always” or “never” effective, so it is important that research investigates the nuances of effects on different individuals.

 

Important steps to making this happen include focusing on conditions rather than interventions and starting with high-cost conditions that have great variation in treatments. While double-blind randomized control trials (RCTs) are often thought of in research as the “gold standard” we need to rethink this. RCTs introduce their own biases and limitations; all data has limitations. We need to understand these limitations and work to triangulate research methods to account for this. 

 

We also need to be spending our healthcare dollars smarter. This will mean realigning incentives. Each year, over 19,000 RCTs and thousands of other studies are conducted on medical interventions, yet systematic reviews show that existing evidence is still inadequate or of poor quality. These studies need broader patient populations, studies of “typical” care by your average clinician, and research questions targeted at decision makers.

 

Next Dr. Alfiee discussed her work on the African American Knowledge Optimized for Mindfully-Healthy Adolescents (AAKOMA) Project, which aims to address mental health disparities for youth of color. Their work is focused on good treatments, not standard treatments. While studies have shown there are equal rates of prevalence of depression among white and black children, there are very different treatment standards for them. Youth of color primarily get their mental health screenings and treatments through the juvenile justice system, which is a huge issue. Their PCORI Engagement Award helped them to build a curriculum for people of color to learn how to develop research ministries focused in black churches. Basing this work in the faith communities has helped to build trust and reduce stigma.

 

Dr. Bulger then discussed his work on increasing uptake of evidence-based practice standards. Research shows that it takes an average of 17 years for evidence-based best practices to become the standard of care. His work came up with five steps to get evidence-based care into practice more quickly: 

Using a total cost of care, collaborative approach brings the highest value to healthcare.

 

In the future it will become increasingly important to research more alternative, preventive, and non-medical interventions as we move to a value-based system. We need to focus on and fund the researchers who are asking those kinds of questions and reward that type of research.