The following guest post on Comparative Effectiveness Research comes from Maria L Kirzecky, R.Ph., MBA, who founded The Kirzecky Group, LLC – a strategic healthcare consultancy specializing in leading organizations to enhance their market position through market-focused business direction, innovative strategies, and sound science-based communications.

Why aren’t we as health care professionals clamoring for CER? Why shouldn’t we encourage health care policy makers and industries to align themselves to how we make clinical decisions? Perhaps we haven’t taken the time to fully understand the benefits of CER, how it could directly improve our ability to positively affect the lives of our patients, or we see it as something far-off and impossibly complex to implement. If we take a closer look at CER in relation to our needs as caregivers and front-line professionals attuned to the health needs of our patients, we can positively shape the debate on health care reform through CER.

The benefits of CER to healthcare professionals (HCPs), patients and other stakeholders
Efficacy, established within the confined settings of clinical trials using RCT is a necessary but not sufficient standard for deciding on how to treat patients for their conditions. Meta-anlaysis alone is not a sufficient way to address the lack of comparative effectiveness information. Performance, in terms of health outcomes, requires HCPs to make our best guess with limited information about which treatments work best for specific patients’ conditions.

Instead of settling for “siloed” information on health care treatments, what if we had richer information at our fingertips which evaluate treatments “relative” to one another and for specific patient types? By providing that kind of comparative information about treatments, CER gets us closer to the real word of how healthcare professionals practice. Instead of seeing healthcare reform getting between patient and doctor, we might look at CER as a significant step toward healthcare reform providing the necessary conduit between patient and healthcare provider by providing this much needed information to both groups.

Comparative treatment information enables us to choose the best treatments for our patients’ conditions. It helps us get to being closer to “right the first time”, limiting risk of using the “new” or latest treatments – just because they are new. Medical costs can also be reduced by not having to backtrack and consider more interventions based on failures, or adding on therapies and possibly creating even greater risks or problems, for example drug interactions resulting from unnecessary poly-pharmacy. In addition, disparities could be justified based on the results or outcomes substantiated in CER, rather than just being highlighted for their financial impact.

Patients and HCPs are not the only ones who will benefit from a performance-driven approach enabled by CER. Comparative information will save manufacturers’ costs by directing them to develop treatments with the most positive outcomes for the most appropriate patients, and away from me-to products with marginal performance value, directed at the masses. Thus, resources could be directed to developing more data rich and innovative products. Payers will appreciate appropriate costs associated with HCPs prescribing appropriate treatments the first time, resulting in improved patient health and reduced need for treatments or defensive medicine techniques.

CER is not a radical, far-off dream – we can do something now

There are those in the health care field who clearly see and desire the benefits of the performance-driven approach of CER, but are concerned that implementing CER is too daunting in scale and complexity to tackle. Here are three ways to look at addressing these concerns and taking steps towards proceeding with CER:

1- Don’t look at CER as an event
Change required for CER is a greater integration of “performance focus” and practices into ongoing organizational operations. Practitioners need to be more engaged with performance and outcomes, and not enticed and drawn to the newest products and technologies until there is reasonable data to support them versus current options. Industry needs to look at innovation from a standpoint of performance versus current options as the litmus test for moving development projects forward, certainly along with other criteria including e.g., patent protection.

2- We’ve actually been doing this a long time…
Comparative effectiveness is how we, as health care professionals, naturally make health care decisions anyway. A patient performance-driven or outcome-based approach to providing health care is not new. Hospital pharmacists in the late 1970′s, with the advent of the Prospective Payment System, began training medical students and residents in teaching hospitals in order to get more appropriate use of medications, by collecting outcomes data through medical records reviews, data based mining from our DRG data bases, and developing guidelines for interventions. In one case, we looked at coronary artery bypass graft (CABG) patients with nutritional depletion prior to surgery to determine whether they did better post op and through recovery based on intervention with total parenteral nutrition (TPN), an expensive treatment in the hospital setting. We were able to prove that the patients did better on this treatment, and in fact the cost of the TPN was offset by the decreased length of stay and other indicators versus the patients who did not receive TPN. The patients on TPN had better outcomes, and had lower hospital charges overall. Needless to say, the study helped to sell a lot of TPN for CABG patients back then. That was CER – in the early days.

3- We’re just gaining the support of more stakeholders
CER puts all stakeholders on the same page with common goals. In an attempt to socialize the concept of CER better than it is currently, goals for improving HCP decision-making and patient-performance establishes a frame which we can all understand, agree on, and anchor the discussion. Who doesn’t want better health care for themselves, family members or friends? While other goals may be important to CER and health care reform in general, they are often in conflict with other stakeholders’ interest, leading to stifled debate and inaction. Why don’t we let performance be our lens, and ensure that all other goals align with it? I’d like us to try and socialize CER from the healthcare provider and patient performance perspective.

Successful models already exist for performance oriented approaches. I was a practicing hospital pharmacist when Dr. Roy Vagelos was running Merck. To the healthcare provider on the outside, the company culture operated like a huge medical practice. Patient-performance criteria provided the context for product development and marketing, and the foundation on which business goals and objectives aligned. Fully recognizing those were different times back then – we also need to recognize that the business did well back then too! Why not revisit this successful model in our attempts to socialize and progress the discussion on how to implement CER?

This entry was posted on Thursday, July 9th, 2009 at 10:00 am and is filed under Comparative Effectiveness Research. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.