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Summary
Pages 1-20

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From page 1...
... CER focuses attention on the evidence base to assist patients and health care providers across diverse health settings in making more informed decisions. They will need useful, practical information concerning the most effective interventions and health care services for their particular situation.
From page 2...
... The committee's principal task was to prepare a list of priorities for CER funding; most of its time was spent developing a process for priority setting, eliciting a wide array of input from the public, and deliberating over a list of nominated research topics. Then, as the complexities of priority setting for CER became apparent, the committee began to outline the development of an infrastructure that would sustain a long-term, national CER effort.
From page 3...
... HCDS Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others. HCDS Compare the effectiveness of comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities.
From page 4...
... MS Establish a prospective registry to compare the effectiveness of treatment strategies for low back pain without neurological deficit or spinal deformity. NEURO Compare the effectiveness and costs of alternative detection and management strategies (e.g., pharmacologic treatment, social/family support, combined pharmacologic and social/family support)
From page 5...
... RED Compare the effectiveness of interventions (e.g., community-based multi-level interventions, simple health education, usual care) to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
From page 6...
... and usual care in managing chronic disease, especially in rural settings. HCDS Compare the effectiveness of diverse models of transition support services for adults with complex health care needs (e.g., the elderly, homeless, mentally challenged)
From page 7...
... and usual care in long-term and end-of-life care of the elderly. PSYCH Compare the effectiveness of pharmacologic treatment and behavioral interventions in managing major depressive disorders in adolescents and adults in diverse treatment settings.
From page 8...
... CAD Compare the effectiveness of aggressive medical management and percutaneous coronary interventions in treating stable coronary disease for patients of different ages and with different comorbidities. CAD Compare the effectiveness of innovative treatment strategies (e.g., cardiac resynchronization, remote physiologic monitoring, pharmacologic treatment, novel agents such as CRF-2 receptors)
From page 9...
... NEURO Compare the effectiveness of comprehensive, coordinated care and usual care on objective measures of clinical status, patient-reported outcomes, and costs of care for people with multiple sclerosis. NUTR Compare the effectiveness of treatment strategies for obesity (e.g., bariatric surgery, behavioral interventions, pharmacologic treatment)
From page 10...
... DIS Compare the effectiveness of focused intense periodic therapy and usual weekly therapy in managing cerebral palsy in children. ENDO Compare the effectiveness of different disease management strategies in improving the adherence to and value of pharmacologic treatments for the elderly.
From page 11...
... for informing patients about proposed treatments during the process of informed consent. HCDS Compare the effectiveness of different disease management strategies for activating patients with chronic disease.
From page 12...
... NOTE: ADDO = Alcoholism, Drug Dependency, and Overdose; BDEV = Birth and Developmental Disorders; CAD = Cardiovascular and Peripheral Vascular Disease; CAM = Complementary and Alternative Medicine; DIS = Functional Limitations and Disabilities; EENT = Eyes, Ears, Nose, and Throat Disorders; ENDO = Endocrinology and Metabolism Disorders and Geriatrics; GI = Gastrointestinal System Disorders; HCDS = Health Care Delivery Systems; IMUN = Immune System, Connective Tissue, and Joint Disorders; INFD = Infectious Diseases Liver and Biliary Tract Disorders; KUT = Kidney and Urinary Tract Disorders; MS = Musculoskeletal Disorders; NEURO = Neurologic Disorders; NUTR = Nutrition (including obesity) ; ONC = Oncology and Hematology; ORAL = Oral Health; PEDS = Pediatrics; PELC = Palliative and End-of-Life Care; PSYCH = Psychiatric Disorders; RD = Respiratory Disease; RED = Racial and Ethnic Disparities; SKIN = Skin Disorders; TEMC = Trauma, Emergency Medicine, and Critical Care Medicine; WH = Women's Health.
From page 13...
... It provides a basis for judging research proposals to perform CER and for evaluating the impact of that research and the success of a national CER Program. In formulating its definition, this committee drew upon definitions by several government agencies and other IOM committees (see Chapter 2)
From page 14...
... These topics were incorporated into the 129 remaining submitted topics without distinguishing them, providing a total of 155 unique nominated research topics for consideration in the third round of voting. PORTFOLIO DISTRIBUTION OF THE PRIORITY TOPICS The committee's goal in examining the list of priority research topics as a portfolio was to include balance across the four dimensions previously mentioned.
From page 15...
... Using this file, readers can sort the list of topics by various portfolio characteristics such as research area, study population, or type of intervention. Recommendations for a robust NATIONAL CER ENTERPRISE Based on stakeholder input and its own deliberations, the committee concluded that the country needs a robust CER infrastructure -- referred to throughout as the "CER Program" -- to sustain CER well into the future, including carrying out the research recommended in this report and studying new topics identified by future priority setting.
From page 16...
... A national CER enterprise should, on an ongoing basis, collate national data concerning the significance of diseases and conditions as well as information about current research gaps and redundancies related to the specific research topics under consideration. The committee found that the descriptions of research topics were often difficult to understand; an opportunity for a priority-setting body to interrogate CER topic nominators would help to clarify the nominator's intent.
From page 17...
... The committee's work, including stakeholder input, revealed the scope of research infrastructure needed to support CER in its goal of improving health care decisions and their implementation. The committee does not attempt to fill in all the details, but it concludes that the country must have a federal organizational infrastructure with appropriate responsibility and authority to coordinate the prioritization process, support the development of necessary databases and registries, fund the training of needed researchers, conduct the research, and support a vigorous translational effort to help bring research findings into everyday clinical practice.
From page 18...
... •  The CER Program should also encourage broad participation in CER in order to create a representative evidence base that could help identify health disparities and inform decisions by patients in special population groups. CER comprises a broad spectrum of established and emerging research methods including clinical trials, observational studies, and systematic r ­ eviews of existing evidence.
From page 19...
... Recommendation 8: The CER Program should help to develop large scale, clinical and administrative data networks to facilitate better use of data and more efficient ways to collect new data to inform CER. •  The CER Program should ensure that CER researchers and institu tions consistently adhere to best practices to protect privacy and maintain security.
From page 20...
... Many barriers exist: perverse reimbursement incentives, physician perceptions about patients' expectations, and patients' concerns about denials of care or their reluctance to question clinicians. The CER Program should require researchers to publish all federally funded CER studies and make the research available to the public.


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