Why the Slow Take-up of Comparative Effectiveness Research? It's Time and Money, Says a New PCORI Survey

Earlier this week, the federal government’s Patient Centered Outcomes Research Institute (PCORI) unveiled a new survey, revealing that both patients and clinicians want in health research to focus on one thing: improving outcomes. A panel of healthcare providers discussed how findings will impact the structure and content of comparative effectiveness research (CER), advocating patient-centric dissemination strategies that position CER research properly within clinician workflows mainly by providing adequate compensation for the time clinicians spend discussing compared treatments with their patients.

The survey says that while patients and physicians value CER, most are not familiar with what it entails. This lack of familiarity about CER as a concept-coupled with the lack of an existing relevant evidence base in areas clinicians look for information-explains why CER is still not commonly used in practice. In order to facilitate more active participation in research, the survey advocated as high-priority strategies the establishment of a link between engagement and patient care, through financial compensation, for use of CER.

The panel identified the main reasons why CER is not a more recognized term among health providers. The simple fact is that information regarding CER and its findings is not widely and/or properly disseminated to clinicians. One place where it makes sense to make systemic changes to workflow is in electronic health records, which are now being phased in as a part of comprehensive health reform.

One panel member, Marc Boutin, JD, Executive Vice President of the National Health Council, argued that CER should not only consider the quality of treatment in providing the best medical outcome, but also the value of patient-preference issues such as cost and timing of treatments. “It comes down to the primary care physician and their receptivity to really understanding the patient in his or her own context, and to help apply the best evidence to that patient,” he said. Boutin said that patients need to be engaged early on in the process, and that the research must be put in proper context for it to have an impact, stating, “Having patients involved in defining the research questions all the way to dissemination of results is a different form of engagement that will dramatically increase understanding and knowledge of CER, and help to foster trust within the patient community.”

Lastly, the panelists discussed overcoming the issue of building time into providers’ schedules for using and engaging in CER research. Barbara Doty of the American Academy for Family Physicians remarked that this issue hinges on the shifting of resources in the health care industry to allocate for more time, and in that, “Time is money. It’s about being able to adequately compensate practices so that they can take the time and use the tools to have a conversation with the patient.”

Many of these conclusions require more study; in this, PCORI at this point may be providing more questions than answers. Nevertheless, the survey and the panel have, for the first time, directly linked the wider use and reliance on CER as a clinical decision-making tool to the financial incentive of providers to do so. In other words, money talks.