MSNV 600 outcomes research

1. Outcomes Research:
The Good, the Bad & the Ugly
Michael Hager, EMS-RN, BSN
MSNV 600
Dr. Catie Chung, PhD, RN, CNE, CCM, WCC

2. The Good
 “Patient-Centered Outcomes Research (PCOR)
helps people and their caregivers communicate and
make informed health care decisions, allowing their
voices to be heard in assessing the value of health
care options” (Patient Centered Outcomes Research
Institute, 2012, p.1).
 The quality and pertinence of evidence regarding the
effectiveness of health-care services is essential to
policy questions related to clinical care,
reimbursement, and, ultimately, public health.

3. The Good
 Comparative Effectiveness Research (CER)
 Patient Protection and Affordable Care Act (PPACA) anticipates
the implementation of CER as a matter of prescribed federal
policy and practice (Thorpe, 2010).
 CER raises important issues for public health
 The Institute of Medicine (IOM), whose study of CER was highly
influential in creating the CER provisions in health reform,
defines CER as the study of methods, including alternative
approaches, to “prevent, diagnose, treat, and monitor a clinical
condition or to improve the delivery of care” and inform decision-
making by “consumers, clinicians, purchasers, and policy
makers (Thorpe, 2010).

4. The Bad
 The IOM definition is extremely broad and potentially
encompasses not only head-to-head comparisons of different
clinical treatments, but also approaches that use community-
and population-level interventions to affect clinical conditions
(Thorpe, 2010).
 The use of cost information in CER is one of the most
controversial issues.
 Supporters argue that without cost information, the utility of CER
to inform clinicians, patients, and payers about the cost-benefit
of various treatments will be limited. Opponents fear that the use
of cost information will limit access to care and limit the
development of new and innovative health-care technologies
(Thorpe, 2010).

5. The Bad
 The IOM definition is extremely broad and potentially
encompasses not only one-on-one comparisons of different
clinical treatments, but also approaches that use community-
and population-level interventions to affect clinical conditions.
 Challengers of a national policy to advance CER raise concerns
regarding its potential to limit access and stymie variation and
innovation in health care to the harm of individuals with rare
conditions or those whose complex health conditions and/or
social risks place treatment outside clinical standards. (Thorpe,
2010).

6. The (not so) Ugly
 Whether narrowly or broadly defined, CER
and the evidence it generates can play a
pivotal role for clinicians, patients, payers,
health professionals, and policy makers.
 The American Recovery and Reinvestment
Act of 2009 (ARRA)4 and the PPACA5
meaningfully move the nation toward a
national CER policy (Thorpe, 2010).

7. Conclusion
 Principal all of these issues will be the point to
which the public health policy is realized in a
manner that restricts the scope of research to
medical interventions or, instead, in a manner
that promotes population health interventions
that direct the prevention, mitigation, or
treatment of chronic conditions among the
public.

8. References
Patient Centered Outcomes Research Institute. (2012). Patient-
Centered Outcomes Research Definition Revision:
Response to Public Input. Retrieved from
http://www.pcori.org/assets/PCOR-Definition-Revised-
Draft-and-Responses-to-Input.pdf
Thorpe, J. H. (2010). Comparative effectiveness research and
health reform: implications for public health policy and
practice. Public Health Reports (Washington, D.C.: 1974),
125(6), 909-912.