Saturday, July 9, 2011

Comparative Effectiveness Research

Having recently been accepted into the MPH Informatics program at Georgia Health Sciences University I visited the campus recently to speak with a program administrator and a faculty member. We tentatively decided that my capstone research would relate to comparative effectiveness research (CER) and possibly to the modeling and simulation of clinical pathways in the context of CER. So it is likely that my posts here will become the evidence of my learning about CER.

In the following video editorial George Lundbery, MD, Editor-at-Large of MedPage today, ( suggests that physicians may resist change in how they treat patients with particular conditions for reason of multiple motivations including money, collegial medical relationships and an aversion to simple remedies.

For what it may be worth, my initial impression is that physicians and others are likely to see evidence-based clinical pathways as a threat to professional autonomy. In the presence of a prescribed clinical pathway physicians may have to justify deviations from the pathway, which can be time consuming and annoying, especially when the physician has sound reasons for not following the evidence-based pathway in the cases of particular patients. If there were a compete set of clinical pathways it would only be by way of "deviance" that continued learning could happen. We are not at risk that through universal compliance with evidence-based pathwyas we will lose the opportunity to learn through variety of physicians' decisions.

As I anticipate my capstone research I hope to discover ways to model and simulate the financial and other implications of alternative clinical pathways in some identified clinical domain. I anticipate finding that no single pathway is optimal in light of every relevant value. I think too often references to the combination of population-based health care and patient-centered medical care are glossed to make it appear that both can be optimized at the same time. I think Dr. Lundbery's editorial suggests that it not as simple as understanding such trade-offs. There is the burden of precedent and comfort with existing practices and cultures that benefit multiple stakeholders. I am not sure his word, "courage" is quite the right word in this context, but perhaps it is.

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