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Rowan P, Whicher D, Luhr M, Miescier L, Kranker K, Gilman B. Supportive Services at End of Life can Help Reduce Acute Care Services: Observations From the Medicare Care Choices Model. Am J Hosp Palliat Care 2023:10499091231216887. [PMID: 37972473 DOI: 10.1177/10499091231216887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study identifies the mechanisms through which supportive and palliative care services at the end-of-life helped prevent unnecessary use of acute care services. BACKGROUND From 2016 to 2021, the Medicare Care Choices Model (MCCM) tested whether offering Medicare beneficiaries the option to receive supportive and palliative care services through hospice providers, concurrently with treatments for their terminal conditions, improved patients' quality of life and care and reduced Medicare expenditures. Previous MCCM evaluation results showed that the model achieved its goals, but did not examine in depth the causal mechanisms leading to these results. METHODS Mixed-methods evaluation based on descriptive analysis of MCCM encounter data and qualitative analysis of interviews with staff from high-performing MCCM hospices. RESULTS MCCM hospices provided 217 156 encounters to 7263 enrollees over 6 years. Enrollees received on average 30 encounters with hospice staff while enrolled in the model, representing about 10 encounters per month enrolled. Most encounters were delivered by clinically trained staff in the patient's home. Hospice staff identified five services critical for keeping patients from seeking acute care services: early and frequent needs assessments, direct observation of patients in their homes, immediate responses to patients' medical complaints, round-the-clock telephone access to nursing staff, and communication and coordination of care with primary care physicians and specialists. CONCLUSIONS Palliative care approaches that are high-touch, employ clinically trained staff who visit patients in their homes, routinely evaluate how to manage patient symptoms, and are available when needs arise can improve outcomes and decrease costs at the end of life.
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Affiliation(s)
| | | | | | - Lynn Miescier
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | | | - Boyd Gilman
- Health Unit, Mathematica, Washington, DC, USA
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Whicher D, Rapp T. The Value of Artificial Intelligence for Healthcare Decision Making-Lessons Learned. Value Health 2022; 25:328-330. [PMID: 35227442 DOI: 10.1016/j.jval.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Thomas Rapp
- University of Paris, Paris, France; Sciences Po, LIEPP, Paris, France
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Brown R, Derzon J, Gilman B, Whicher D, Dale S. Features of health care interventions associated with reduced services and spending. Am J Manag Care 2021; 27:e378-e385. [PMID: 34784146 DOI: 10.37765/ajmc.2021.88781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study examines 14 independent and diverse health care interventions funded under the second round of Health Care Innovation Awards by CMS to determine if any organizational, model, or implementation features were strongly associated with the programs' estimated impacts on total expenditures, hospitalizations, or emergency department visits. STUDY DESIGN We estimated program impacts using awardee-specific difference-in-differences models based on Medicare and Medicaid enrollment and claims data for treatment and matched comparison groups from 2012 to 2018. METHODS We used 2 analytic approaches to identify program features associated with favorable impacts. The first method identified program characteristics that were common among programs that had estimated reductions in costs and service use and uncommon among those that did not. The second approach compared median impacts among awardees with a given distinguishing feature with median impacts among awardees that lacked the characteristic. RESULTS Of the 23 program features examined, 7 were associated with favorable estimated impacts: 3 intervention components (behavioral health, telehealth, and health information technology) and 4 program design and organizational characteristics (having prior experience implementing similar programs, targeting patients with substantial nonmedical needs in addition to medical problems, being focused on individual patient care rather than transforming provider practice, and using nonclinical staff as frontline providers of the intervention). CONCLUSIONS Innovative health care service delivery models with 2 or more of these 7 identified features were more likely than programs without them to reduce Medicare and Medicaid beneficiaries' needs for costly health care services.
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Affiliation(s)
| | | | - Boyd Gilman
- Mathematica, Inc, 955 Massachusetts Ave, Ste 801, Cambridge, MA 02138.
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Asch DA, Joffe S, Bierer BE, Greene SM, Lieu TA, Platt JE, Whicher D, Ahmed M, Platt R. Rethinking ethical oversight in the era of the learning health system. Healthc (Amst) 2020; 8:100462. [PMID: 32992106 DOI: 10.1016/j.hjdsi.2020.100462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
Opportunities to advance science increasingly arise through investigations embedded within routine clinical practice in the form of learning health systems. Such activities challenge conventional approaches to research regulation that have not caught up with those opportunities, often imposing burdens generalized from riskier research. We analyze the rules and conventions in the US, demonstrating how even those rules are compatible with a much more flexible approach to participant risk, institutional oversight, participant consent, and disclosure for low-risk learning activities in all jurisdictions.
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Affiliation(s)
- David A Asch
- University of Pennsylvania, Philadelphia, PA, USA; Cpl Michael J Crescenz VA Medical Center, Philadelphia, PA, USA.
| | - Steven Joffe
- University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara E Bierer
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Tracy A Lieu
- Kaiser Permanente Northern California, The Permanente Medical Group, Oakland, CA, USA
| | - Jodyn E Platt
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Richard Platt
- Harvard Medical School, Boston, MA, USA; Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Affiliation(s)
- Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education & Clinical Care Service, Tennessee Valley Healthcare System VA, Nashville
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Abstract
A learning health system provides opportunities to leverage data generated in the course of standard clinical care to improve clinical practice. One such opportunity includes a clinical decision support structure that would allow clinicians to query electronic health records (EHRs) such that responses from the EHRs could inform treatment recommendations. We argue that though using a clinical decision support system does not necessarily constitute a research activity subject to the Common Rule, it requires more ethical and regulatory oversight than activities of clinical practice are generally subjected to. In particular, we argue that the development and use of clinical decision support systems should be governed by a framework that (1) articulates appropriate conditions for their use, (2) includes processes for monitoring data quality and developing and validating algorithms, and (3) sufficiently protects patients' data.
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Affiliation(s)
- Emily L Evans
- A program officer for the Clinical Effectiveness and Decision Science program at the Patient-Centered Outcomes Research Institute (PCORI) in Washington, DC, and served as a consultant to the Institute of Medicine Committee on Ethical and Scientific Issues in Studying the Safety of Approved Drugs and as a member of research teams at the Johns Hopkins School of Medicine
| | - Danielle Whicher
- A senior program officer for the Leadership Consortium for a Value and Science-Driven Health System at the National Academy of Medicine in Washington, DC, and previously a program officer for the Clinical Effectiveness and Decision Science program at the Patient-Centered Outcomes Research Institute, a project coordinator at the Johns Hopkins Berman Institute for Bioethics, and a guest lecturer at Johns Hopkins Bloomberg School of Public Health
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Whicher D, Philbin S, Aronson N. An overview of the impact of rare disease characteristics on research methodology. Orphanet J Rare Dis 2018; 13:14. [PMID: 29351763 PMCID: PMC5775563 DOI: 10.1186/s13023-017-0755-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background About 30 million individuals in the United States are living with a rare disease, which by definition have a prevalence of 200,000 or fewer cases in the United States ([National Organization for Rare Disorders], [About NORD], [2016]). Disease heterogeneity and geographic dispersion add to the difficulty of completing robust studies in small populations. Improving the ability to conduct research on rare diseases would have a significant impact on population health. The purpose of this paper is to raise awareness of methodological approaches that can address the challenges to conducting robust research on rare diseases. Approach We conducted a landscape review of available methodological and analytic approaches to address the challenges of rare disease research. Our objectives were to: 1. identify algorithms for matching study design to rare disease attributes and the methodological approaches applicable to these algorithms; 2. draw inferences on how research communities and infrastructure can contribute to the efficiency of research on rare diseases; and 3. to describe methodological approaches in the rare disease portfolio of the Patient-Centered Outcomes Research Institute (PCORI), a funder promoting both rare disease research and research infrastructure. Results We identified three algorithms for matching study design to rare disease or intervention characteristics (Gagne, et.al, BMJ 349:g6802, 2014); (Gupta, et.al, J Clin Epidemiol 64:1085-1094, 2011); (Cornu, et. al, Orphet J Rare Dis 8:48,2012) and summarized the applicable methodological and analytic approaches. From this literature we were also able to draw inferences on how an effective research infrastructure can set an agenda, prioritize studies, accelerate accrual, catalyze patient engagement and terminate poorly performing studies. Of the 24 rare disease projects in the PCORI portfolio, 11 are randomized controlled trials (RCTs) using standard designs. Thirteen are observational studies using case-control, prospective cohort, or natural history designs. PCORI has supported the development of 9 Patient-Powered Research Networks (PPRNs) focused on rare diseases. Conclusion Matching research design to attributes of rare diseases and interventions can facilitate the completion of RCTs that are adequately powered. An effective research infrastructure can improve efficiency and avoid waste in rare disease research. Our review of the PCORI research portfolio demonstrates that it is feasible to conduct RCTs in rare disease. However, most of these studies are using standard RCT designs. This suggests that use of a broader array of methodological approaches to RCTs --such as adaptive trials, cross-over trials, and early escape designs can improve the productivity of robust research in rare diseases.
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Affiliation(s)
- Danielle Whicher
- National Academy of Medicine, 500 5th Street NW, Washington, DC, 20001, USA.
| | - Sarah Philbin
- Patient-Centered Outcomes Research Institute (PCORI), 1919 M Street NW, Washington, DC, 20036, USA
| | - Naomi Aronson
- Blue Cross Blue Shield Association, 300 E Randolph Street, Chicago, IL, 60601, USA
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Abstract
National regulations governing human subjects research differ with regard to whether they require survey research to be overseen by institutional ethics boards or committees. In cases where ethical review has been waived, or was provided by an individual or group other than an institutional ethics board, journals may question the appropriateness of the waiver or alternative review when making determinations about whether to accept the manuscript for publication. The purpose of this article is to provide guidance for journals to consider when making determinations about the necessity of ethical review for survey research projects. We review the functions of ethics oversight and consider the importance of those functions within the context of survey research. In survey research, no intervention is delivered to research participants. As a result, there is no risk of physical harm to individuals who participate. However, there can be a risk of informational or psychological harms. In situations where there is greater than minimal risk of informational or psychological harms, the survey research should have received institutional ethics oversight. Additionally, survey research projects that enroll vulnerable individuals with diminished autonomy should receive institutional ethics oversight. We hope that this article leads to further guidance on this subject by authoritative group such as the International Committee of Medical Journal Editors.
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Affiliation(s)
- Danielle Whicher
- Patient Centered Outcomes Research Institute (PCORI), 1919 M Street, NW, Suite 250, Washington, DC, 20036, USA.
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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Whicher D, Kass N, Saghai Y, Faden R, Tunis S, Pronovost P. The views of quality improvement professionals and comparative effectiveness researchers on ethics, IRBs, and oversight. J Empir Res Hum Res Ethics 2015; 10:132-44. [PMID: 25742674 DOI: 10.1177/1556264615571558] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recently, there have been increasing numbers of activities labeled as either quality improvement (QI) or comparative effectiveness research (CER), both of which are designed to learn what works and what does not in routine clinical care settings. These activities can create confusion for researchers, Institutional Review Board members, and other stakeholders as they try to determine which activities or components of activities constitute clinical practices and which constitute clinical research requiring ethical oversight and informed consent. We conducted a series of semi-structured focus groups with QI and CER professionals to understand their experiences and views of the ethical and regulatory challenges that exist as well as the formal or informal practices and criteria they and their institutions use to address these issues. We found that most participants have experienced challenges related to the ethical oversight of QI and CER activities, and many believe that current regulatory criteria for distinguishing clinical practice from clinical research requiring ethical oversight are confusing. Instead, many participants described other criteria that they believe are more ethically appropriate. Many also described developing formal or informal practices at their institutions to navigate which activities require ethical oversight. However, these local solutions do not completely resolve the issues caused by the blurring of clinical practice and clinical research, raising the question of whether more foundational regulatory changes are needed.
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Affiliation(s)
| | - Nancy Kass
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Ruth Faden
- Johns Hopkins University, Baltimore, MD, USA
| | - Sean Tunis
- Center for Medical Technology Policy, Baltimore, MD, USA
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Whicher D, Kass N, Faden R. Stakeholders' Views of Alternatives to Prospective Informed Consent for Minimal-Risk Pragmatic Comparative Effectiveness Trials. J Law Med Ethics 2015; 43:397-409. [PMID: 26242962 DOI: 10.1111/jlme.12256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As interest in comparative effectiveness research grows, questions have emerged regarding whether it is ever acceptable to alter informed consent requirements for research when patients are randomly assigned to widely-used therapies. This paper reports on interviews with Institutional Review Board members and researchers and on focus groups with patients from Geisinger and Johns Hopkins health systems. The objective was to elicit participants' views of the acceptability of four different disclosure and authorization models for low-risk pragmatic comparative effectiveness trials of widely-used therapies. Results suggest that although participants valued autonomous choice, many also believed that it was acceptable to streamline information disclosure and to use an opt-out process for eligible individuals who would prefer not to participate. This provides some preliminary evidence that relevant stakeholders find alternatives to traditional informed consent acceptable for low-risk pragmatic comparative effectiveness trials of widely-used therapies as long as a sufficient amount of choice is preserved.
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Affiliation(s)
- Danielle Whicher
- Program Officer at the Patient Centered Outcomes Research Institute (PCORI). All of the work described in this manuscript was completed while Dr. Whicher was a Ph.D. candidate at the Johns Hopkins Bloomberg School of Public Health and a research coordinator at the Johns Hopkins Berman Institute of Bioethics and does not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee. She received her Ph.D. and M.H.S. from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD and her B.A. from Colgate University in Hamilton, NY
| | - Nancy Kass
- Deputy Director for Public Health in the Berman Institute of Bioethics and the Phoebe R. Berman Professor of Bioethics and Public Health at the Johns Hopkins Bloomberg School of Public Health in the Department of Health Policy and Management. She received her Sc.D. from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD and her B.A. from Stanford University in Stanford, CA
| | - Ruth Faden
- Andreas C. Dracopoulos Director and Philip Franklin Wagley Professor at the Johns Hopkins Berman Institute of Bioethics. She received her Ph.D. and M.P.H. from the University of California, Berkeley in Berkeley, CA, her M. A. from the University of Chicago in Chicago, Il and her B.A. from the University of Pennsylvania in Philadelphia, PA
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Heard KR, Wu W, Li Y, Zhao P, Woznica I, Lai JH, Beinborn M, Sanford DG, Dimare MT, Chiluwal AK, Peters DE, Whicher D, Sudmeier JL, Bachovchin WW. A General Method for Making Peptide Therapeutics Resistant to Serine Protease Degradation: Application to Dipeptidyl Peptidase IV Substrates. J Med Chem 2013; 56:8339-51. [DOI: 10.1021/jm400423p] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Kathryn R. Heard
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Wengen Wu
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Youhua Li
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Peng Zhao
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Iwona Woznica
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Jack H. Lai
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Martin Beinborn
- Molecular Pharmacology
Research Center, Molecular Cardiology Research Institute, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts 02111, United States
| | - David G. Sanford
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Matthew T. Dimare
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Amrita K. Chiluwal
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Diane E. Peters
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - Danielle Whicher
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - James L. Sudmeier
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
| | - William W. Bachovchin
- Department of Biochemistry, Tufts University Sackler School of Graduate Biomedical Sciences, 136 Harrison Avenue, Boston, Massachusetts 02111, United States
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Chalkidou K, Tunis S, Whicher D, Fowler R, Zwarenstein M. The role for pragmatic randomized controlled trials (pRCTs) in comparative effectiveness research. Clin Trials 2012; 9:436-46. [PMID: 22752634 DOI: 10.1177/1740774512450097] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a growing appreciation that our current approach to clinical research leaves important gaps in evidence from the perspective of patients, clinicians, and payers wishing to make evidence-based clinical and health policy decisions. This has been a major driver in the rapid increase in interest in comparative effectiveness research (CER), which aims to compare the benefits, risks, and sometimes costs of alternative health-care interventions in 'the real world'. While a broad range of experimental and nonexperimental methods will be used in conducting CER studies, many important questions are likely to require experimental approaches - that is, randomized controlled trials (RCTs). Concerns about the generalizability, feasibility, and cost of RCTs have been frequently articulated in CER method discussions. Pragmatic RCTs (or 'pRCTs') are intended to maintain the internal validity of RCTs while being designed and implemented in ways that would better address the demand for evidence about real-world risks and benefits for informing clinical and health policy decisions. While the level of interest and activity in conducting pRCTs is increasing, many challenges remain for their routine use. This article discusses those challenges and offers some potential ways forward.
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Tunis S, Whicher D. The need to engage stakeholders in defining, designing, and implementing clinical trials. Oncology (Williston Park) 2010; 24:1057-1058. [PMID: 21155459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Sean Tunis
- Center for Medical Technology Policy, World Trade Center, Baltimore, USA
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Mullins CD, Whicher D, Reese ES, Tunis S. Generating evidence for comparative effectiveness research using more pragmatic randomized controlled trials. Pharmacoeconomics 2010; 28:969-976. [PMID: 20831305 DOI: 10.2165/11536160-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Comparative effectiveness research (CER), or research design to meet the needs of post-regulatory decision makers, has been brought into the spotlight with the introduction of the American Recovery and Reinvestment Act, which provided $US1.1 billion over 2 years to support CER. In the short run, the majority of this money will be invested in observational studies and building of infrastructure; however, in the long run, we will likely see an increase in the number of randomized controlled trials (RCTs), as this method is arguably the most unbiased approach for establishing causal effect between treatments and health outcomes. RCTs are an integral component of CER for generating credible evidence on the relative value of alternative interventions in order to meet the needs of post-regulatory decision makers (patients, physicians, payers and policy makers). Explanatory phase III RCTs are fit for purpose; researchers make use of guidance documents produced by the US FDA to inform the design of these clinical trials. Historically, without explicit FDA guidance, broad patient populations, including women and minorities, often were not considered in trial design. In addition, attempts to minimize cost and maximize efficiency have led to smaller sample sizes, as is clear from the increase in 'creeping phase II-ism'. To demonstrate effectiveness, RCTs must be reflective of how an intervention will be used in the healthcare market. The concept of pragmatic clinical trials has emerged to describe those trials that are designed explicitly with this need in mind. Use of pragmatic trials will be most impactful if post-regulatory decision makers are engaged in the development of recommendations for trial design features, such as indicating outcomes measures and articulating patient populations of interest, which clearly express their evidence needs.
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Affiliation(s)
- C Daniel Mullins
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Whicher D, Currie P, Taylor HA. Factors that influence institutional review board members' commitment to their role responsibilities. IRB 2009; 31:15-19. [PMID: 19873837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Danielle Whicher
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Luce BR, Kramer JM, Goodman SN, Connor JT, Tunis S, Whicher D, Schwartz JS. Rethinking randomized clinical trials for comparative effectiveness research: the need for transformational change. Ann Intern Med 2009; 151:206-9. [PMID: 19567619 DOI: 10.7326/0003-4819-151-3-200908040-00126] [Citation(s) in RCA: 257] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bryan R Luce
- United BioSource Corporation, Bethesda, Maryland 20814, USA.
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Tunis S, Whicher D. The National Oncologic PET Registry: lessons learned for coverage with evidence development. J Am Coll Radiol 2009; 6:360-5. [PMID: 19394577 DOI: 10.1016/j.jacr.2009.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 01/22/2009] [Indexed: 10/20/2022]
Abstract
The National Oncologic PET Registry (NOPR) was one of the first attempts of the Centers for Medicare & Medicaid Services (CMS) at coverage with evidence development. Under this coverage policy, the agency will provide payment for a technology only if patients and providers agree to enroll in a prospective study or registry. The NOPR was designed to determine if the results of positron emission tomography scans influence physicians' intended plans of patient management while imposing minimal restrictions on the use of such scans in the clinical setting. The experience of policymakers, methodologists, physicians, and patients with the NOPR provides some useful insights into the utility and challenges of implementing, financing, and creating a robust methodology for coverage with evidence development in the future. Moving to a system of evidence-based medical technology diffusion will require all health care decision makers to become involved in evidence generation and reach an agreement about the type of evidence required to make informed medical decisions.
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Affiliation(s)
- Sean Tunis
- Center for Medical Technology Policy, Baltimore, Maryland 21202, USA.
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