Putting 'effect' into comparative-effectiveness research

With the federal government putting $1.1 billion into comparative-effectiveness research, two Baylor College of Medicine researchers advocate investing in finding ways to put that science into practice in doctors' offices and clinics across the nation.

'We need to pay as much attention as to how the evidence is put into practice as to the evidence itself,' said Dr Laura A. Petersen, chief of the section of health services research in the department of medicine at BCM and director of the Veterans Affairs Health Services Research and Development Centre of Excellence. Petersen, also an associate professor of medicine at BCM, and Dr Aanand D. Naik, an assistant professor of medicine and investigator in the VA Centre of Excellence, discussed the need for a new emphasis in implementing the results of comparative-effectiveness research in a Perspective in the current issue of the New England Journal of Medicine.

'How do you get evidence into practice?' she said. 'We need to study that with the same intensity as we go about getting the evidence.'

Comparative-effectiveness research means scientifically evaluating drugs, medical devices, surgical procedures and other treatments to determine which provides the highest quality at a reasonable price. As the Obama Administration seeks to cut the costs of health care without affecting quality, the emphasis on comparative-effectiveness research has intensified.

'We do great research, and it ends up on the shelf. It takes an average of 17 years for research to get into practice,' said Petersen.

'We expect doctors and healthcare providers to know what is the right thing and then to put it into action. We know that is not happening,' she said.

In the Perspective, she and Naik describe how studies in the early 1990s showed that using a balloon technique to open clogged coronary arteries in the heart after a heart attack worked better than treatment with clot-busting drugs. Yet 10 years after the first publication of these studies, less than one-third of hospitals were providing the balloon technique within the time period needed for high quality care. Now experts are developing ways to put the life-saving treatment into effective practice more widely among the nation' hospitals.