How Will Comparative Effectiveness Research Affect the Quality of Health Care?

Timely Analysis of Immediate Health Policy Issues, 2010

15 Pages Posted: 23 Feb 2010

See all articles by Elizabeth Docteur

Elizabeth Docteur

Elizabeth Docteur Consulting

Robert A. Berenson

The Urban Institute

Date Written: February 19, 2010


Clinical research has long included investigation of the relative effectiveness of alternative treatments, and physicians have long sought valid comparative effectiveness research to help guide clinical decision-making. Although some proponents of a new focus on such research suggest that new research methods are needed to improve its utility for clinicians and other decision-makers, the basic approach of comparing the effectiveness of alternative interventions is well established.

Despite the fact that comparative effectiveness is not new and the need for the kind of information it generates is virtually uncontested, the question of enhanced public focus on comparative effectiveness remains highly controversial, with articulated fears relating to the potential use and especially the misuse of the findings generated by the research. Any efforts to move forward must do so in ways that are cognizant of the concerns that have been raised and that actively seek to minimize risks while maximizing potential benefits. Those potential benefits are indeed significant, given the large variation in practice, including overuse, underuse and even misuse of clinically appropriate health services and medicines.

An increased investment in prioritizing, coordinating and developing research on the effectiveness of alternative treatments and approaches to health care delivery has the potential to improve quality of care and health outcomes, while increasing value for money and perhaps generative savings. However, all depends on producing comparative research that is more relevant and timely for patients, clinicians, and payers, and on the successful integration of research findings into practice – and the track record in this respect is poor. Without an effective strategy to engage health-care professionals in changing practice in line with evidence, the impact of research on quality and costs will likely be minimal. Furthermore, for the new investment in comparative effectiveness research to have a significant and prompt impact on clinical decision-making, structural changes in areas like payment incentives, health information technology, and the liability environment are needed. Past experience with government-led efforts to influence medical practice suggests the need to tread carefully, engaging public support and the engagement of the medical profession in efforts to improve care and health outcomes.

Keywords: comparative effectiveness research, health system reform, evidence-based medicine, coverage decision, quality, outcomes

JEL Classification: l11, l18

Suggested Citation

Docteur, Elizabeth and Berenson, Robert A., How Will Comparative Effectiveness Research Affect the Quality of Health Care? (February 19, 2010). Timely Analysis of Immediate Health Policy Issues, 2010, Available at SSRN:

Elizabeth Docteur (Contact Author)

Elizabeth Docteur Consulting ( email )

633 S. Saint Asaph Street
Washington, DC 22314-4118
United States

Robert A. Berenson

The Urban Institute ( email )

2100 M Street, NW
Washington, DC 20037
United States

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