Improving comparative effectiveness research

In June 2012, just before the Supreme Court of the United States narrowly affirmed the constitutionality of the Affordable Care Act, the Patient Centered Outcomes Research Institute (PCORI) issued a mandated draft report that provides an initial methodological blueprint for the conduct of research into comparative effectiveness.1 PCORI was established in 2010 as part of the act, which aims to expand access to health insurance to many of the estimated 50 million uninsured Americans. It was inspired by the view that reliable evidence about which health services work best for which patients is needed to inform clinical decisions and health policy decisions in the context of this historic overhaul of the US healthcare system.

The PCORI report offers a concise and coherent set of observations about the flaws in the current US health research enterprise and it discusses how PCORI aims to remedy this. It shows that the institute is thinking seriously about how to put into practice the concept of “patient centredness” in research, taking a term that was originally generated for political reasons and translating it into an executable approach to evidence development. The report offers a framework for thinking about the process of determining which methods would be most appropriate for tackling specific research questions. It also compiles an initial set …