In a blog way last July, we left the discussion of the differences between Evidence-based Medicine (EBM) and Comparative Effectiveness Research (CER) to another day. Today is the day.
We called CER a child of EBM…
…especially in the light of healthcare reform. CER is more of an effort to directly compare available treatments. The official Institute of Medicine definition of CER is “evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.” The fact that CER can address cost and benefits at the policy or population level makes it more controversial. 
Healthcare reform is relevant. ARRA allocated $1.1 billion for CER research. They also created a Federal Coordinating Council for Comparative Effectiveness Research (FCCCER), a very long name. Some of the basics of CER, as described by the FCCCER, include its applicability to the real world and its requirement that the outcomes must matter to patients. Data for CER can come from real life situation such as data either drawn from, or aggregated from, electronic health records. Patients may be given options for diagnosis and treatment based on the results of real-life information.
Medical Librarians have long been involved in teaching EBM and they will also have a role in CER. A recent article published by the Medical Library Association offers the following comparison of EBM and CER. 
|Homogenous populations||Heterogeneous populations|
|Intervention vs. control||Intervention vs. intervention|
|Randomized controlled trial (RCT)||Pragmatic RCT, observational cohort, systematic reviews|
|Cost not usually considered||Cost sometimes considered|
As we move in the direction that the federal government would like to see us move with CER and healthcare reform……toward healthcare that is Patient Centered, Prevention Oriented, Efficient, Equitable and Evidence Based, it behooves us to understand some of these simple, yet widely misunderstood, concepts such as EBM and CER. Our goal at Anthelio is to help our client hospitals bend the cost curve in healthcare so they can invest is what really makes a difference for patients. Concepts such as CER may help our client hospitals to succeed in achieving this “big 5”.
2. Goodrich, K, et. al. Understanding Comparative Effectiveness Research, MLA News, 52(1): 1 January 2012.
Written by Debi Warner, Clinical Librarian, Anthelio Healthcare Solutions
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