the effectiveness and value of health care, the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care convened a workshop on July 30–31, 2008, titled Learning What Works: Infrastructure Required for Comparative Effectiveness Research. Box S-1 describes the issues that motivated the meeting’s discussions: the substantial and growing interest in activities and approaches related to CER; the lack of coordination of key activities, such as the selection and design of studies, synthesis of existing evidence, methods innovation, and translation and dissemination of CER information; shortfalls and widening gaps in the workforce needed in all areas of CER; the opportunities presented by the recent calls for expanded resources for work on the comparative effectiveness of clinical interventions; the growing appreciation of the infrastructure needed to support this work; and the need for a trusted, common venue to identify and characterize the need categories, begin to estimate the shortfalls, consider approaches to addressing the shortfalls, and identify priority next steps.
Issues Motivating the Discussion
- Substantial demand for greater insights into the comparative clinical effectiveness of clinical interventions and care processes to improve the effectiveness and value of health care.
- Expanded interest and activity in the work needed—e.g., comparative effectiveness research, systematic reviews, innovative research strategies, clinical registries, coverage with evidence development.
- Currently fragmented and largely uncoordinated selection of studies, study design and conduct, evidence synthesis, methods validation and improvement, and development and dissemination of guidelines.
- Expanding gap in workforce with skills to develop data sources and systems, design and conduct innovative studies, translate results, and guide application.
- Opportunities presented by the attention of recent initiatives and the increasing possibility of developing an entity and resources for expanded work on the comparative effectiveness of clinical interventions.
- Growing appreciation of the importance of assessing the infrastructure needed for this work—e.g., workforce needs, data linkage and improvement, new methodologies, research networks, technical assistance.
- Desirability of a trusted, common venue to identify and characterize the need categories, begin to estimate the shortfalls, consider approaches to addressing the shortfalls, and identify priority next steps.