Bringing Evidence from Research to the Bedside

Carolyn M. Clancy, MD - AHRQ Director
Carolyn M. Clancy, MD – AHRQ Director

Scientific evidence is the foundation of an advanced healthcare system. While the U.S. medical research enterprise might be the envy of the world, we face a significant challenge in rapidly and reliably bringing the fruits of our research to actual patients. The AHRQ champions the national effort to develop a base of evidence that fosters high-quality healthcare, as well as works to ensure that that research reaches and benefits everyone soon after it emerges.

As one of 12 agencies within the HHS, AHRQ’s mission is to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans. Supporting and disseminating scientific evidence to bolster American medicine is central to this mission. AHRQ, which funds and engages in health-services research that seeks to improve healthcare, is proud to partner with and support other agencies, as well as the private sector in order to improve the quality of care delivered in the U.S. 

Accelerating Patient-Centered Outcomes Research

In recent years, AHRQ’s name commonly has been associated with patient-centered outcomes research. This is due, in part, to the American Recovery and Reinvestment Act of 2009 (Recovery Act), but AHRQ’s commitment to patient-centered outcomes research significantly predates that Act.

AHRQ’s Effective Health Care Program is the nation’s longest-standing commitment to patient-centered outcomes research, sometimes known as comparative effectiveness research.  This research looks at existing studies to compare what works and what doesn’t and for what kind of patient and conducts new studies. Its goal: to help clinicians and patients make more informed decisions about what to do about a medical problem. Since the Effective Health Care Program was established, as a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, it has produced reports on more than 100 products, including comparative-effectiveness reviews, technical briefs, new research and summary publications that disseminate the results of this important research to clinicians, consumers and others.

In the years since the Effective Health Care Program was established, we have learned many things about patient-centered outcomes research.

First, we have come to understand that healthcare as it is practiced in the real world can be very different from medical science as proposed in a laboratory. While randomized, controlled trials remain the gold standard for testing new drugs, procedures and interventions, we have come to understand that patient-centered outcomes research reflects very real questions (e.g., patient adherence) that healthcare confronts every day. We have, therefore,  tried diligently to ensure that our research reflects this. For instance, a comparative-effectiveness review published recently on diagnosis and treatment of attention deficit hyperactivity disorder found that parent behavior training was backed by strong evidence of effectiveness to treat ADHD in children under age 6. However, the researchers also acknowledged that a major barrier is parents dropping out of these rigorous training regimens.

Second, we have learned a great deal about how clinicians absorb information. The traditional method has been to learn of scientific advancements episodically, one study at a time. Many clinicians came to these studies without knowing of some studies that had been conducted previously, thus were learning without benefit of context. This is why it can take years for innovations in healthcare to become actual practice. The Effective Health Care Program has, therefore, made it a significant priority to translate its research into usable information for clinicians by summarizing the state of the science today.

“The AHRQ champions the national effort to develop a base of evidence that fosters high-quality healthcare and works to ensure that that research reaches and benefits everyone quickly after it emerges.”

Third, the importance of dissemination to consumers has become clear. The work of the Effective Health Care Program always was intended to reach a broad audience. As the program has grown, the need to translate this research to multiple communities, including consumers, has only increased. Thus, AHRQ has recommitted to bringing this research to patients by working with the John M. Eisenberg Center for Clinical Decisions and Communications Science in Houston at Baylor College of Medicine to create products for consumers. Recent publications of great consumer interest include summaries on treating sleep apnea, treatments for acid-reflux disease and choosing medicines to treat high blood pressure.

The Recovery Act gave patient-centered outcomes research an unquestioned and unprecedented boost: a $1.1 billion investment to accelerate the effort to compare the evidence of treatments and interventions. AHRQ received a substantial portion of this investment, making patient-centered outcomes research a top priority for the agency. More recently, a new area of focus is the establishment of the Patient-Centered Outcomes Research Institute (PCORI), which was mandated by the 2010 Patient Protection and Affordable Care Act. PCORI, by law an independent, non-profit organization, will further advance patient-centered outcomes research by commissioning studies that are guided by patients, caregivers and the broader health-care community. PCORI will support the development and dissemination of high integrity, evidence-based information that patients can use to make real-world decisions. I am honored to join my colleague Francis S. Collins, MD, PhD, director of the National Institutes of Health, in serving on PCORI’s Board of Governors, along with 19 other highly qualified individuals appointed by the U.S. Government Accountability Office.

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