The Institute of Medicine Releases Initial Comparative Effectiveness Research Priorities

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A new report from the Institute of Medicine (IOM) released in June 2009 recommends 100 initial health topics for priority attention and funding from a new national comparative effectiveness research effort to identify which health care services work best. The report also spells out actions and resources needed to ensure that this initiative will be a sustained effort with a continuous process for updating priorities as needed and that the results are put into clinical practice.

A committee convened by the IOM developed the list of priority topics at the request of Congress as part of a $1.1 billion effort to improve the quality and efficiency of health care through comparative effectiveness research outlined in the American Recovery and Reinvestment Act of 2009. The committee says its report provides independent guidance—informed by extensive public input—to Congress and the secretary of the US Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care.

Health experts and policy makers anticipate that comparative effectiveness research will yield greater value from America's health care system and better outcomes for patients. Despite spending more on care than any other industrialized nation—$2.4 trillion in 2008—the United States lags behind other countries on many measures of health, such as infant mortality and chronic disease burden.

“Health care decisions too often area matter of guesswork because we lack good evidence to inform them,” said committee co-chair Harold C. Sox. “For example, we spend a great deal on diagnostic tests for coronary heart disease in this country, but we lack sufficient evidence to determine which test is best.”

The IOM says the 100 priority areas reflect the insights of health professionals, consumer advocates, policy analysts, and others who submitted nominations through an on-line form that was open to any individual or organization and through presentations at public meetings. The committee received 1,268 unique topic suggestions, which it narrowed to 100 based on a set of criteria that included its charge to develop a balanced portfolio. The list reflects a range of clinical categories, populations to be studied, categories of interventions, and research methodologies.

The report also recommends actions necessary to establish an ongoing comparative effectiveness research effort that would not only carry out studies on the 100 recommended initial topics, but also develop priorities for future research and translate the knowledge gained into improvements in clinical care. It notes that effective coordination and governance among the agencies and disciplines involved will be crucial for ensuring the sustainability of the enterprise and that a skilled work force is needed to carry out the research.

Prepublication copies of Initial National Priorities for Comparative Effectiveness Research are available from the National Academies Press (phone: 202-334-3313 or 1-800-624-6242) or on the Internet at http://www.nap.edu. For a free copy of the report in brief, see: http://www.nap.edu/catalog.php?record_id=12648#aboutprepub.