Comparative effectiveness research groups poised to bring benefits

Medical institutions would benefit from investing in comparative effectiveness research (CER) by creating research groups specific to the field, according to a review published in the March issue of the American Journal of Roentgenology.

Aimed at reducing costs and bettering patient outcomes, CER is still a relatively new field and does not come without its challenges. Lead author Jennifer S. McDonald, PhD, of the Mayo Clinic in Rochester, Minn., and colleagues discussed the best ways to pursue CER within radiology after the creation of a CER unit in their institution’s radiology department.

The CER unit pinpointed several challenges that can arise when pursuing CER. Radiology’s inherent design—including both diagnostic and interventional exams and procedures—poses the first potential issue. Diagnostic examinations are interpreted by the ordering physicians, meaning that they influence but don’t necessarily determine the outcomes, according to the authors. Comprising only one part of patient care, the exams cannot fully illustrate causal links. A better way to observe the effects of diagnostic examinations on patient outcomes may be achieved through simulation and modeling.

Ordering physicians serve as another piece in the CER puzzle, as many nonradiologists order exams. Practice patterns therefore need to be changed, which can be achieved through involvement, robust study findings, and automated tools like decision support software and standardized interpretation comments.

Rapidly evolving technology in the realm of radiology is another obstacle for CER. These studies need to be conducted in a timely manner in order to avoid losing their applicability if a technologic improvement becomes obsolete.

Moreover, studies that compare interventions that run across medical specialties or departments can lead to conflict. Some may believe that the studies are trying to discredit their specialty or take patients. Disputes like these can be avoided by involving members from all departments and specialties that utilize the interventions being compared. Also, national CER studies can depersonalize any comparisons made.

Time can be another problem for CER units, as well as limited personnel. Institutions also need a great deal of funding due to the high costs of conducting CER studies. However, radiology departments with limited resources can still perform CER studies. To do so, they need to consider pursuing specific types of studies, identify inexpensive patient data sources, and collaborate with other departments and institutions, wrote McDonald and colleagues.

“CER promises to promote better patient and physician decision making, enhance the delivery of health care, and ultimately improve patient outcomes. Medical institutions and departments would benefit from investing in this new field by creating research groups focused on CER,” concluded the authors.