Using comparative effectiveness research to improve the health care system

Challenges for implementing the findings of comparative effectiveness research (CER) have been highlighted by the November 2009 mammography screening guideline controversy, according to an analysis published in June 2010 Academy Health Reports.

The analysis, conducted by Michael Gusmano, a research scholar at The Hastings Center, and Bradford Gray, a senior fellow at the Urban Institute, referenced strong objections to mammography screening recommendations released by the US Preventive Services Task Force (USPSTF) that would have reduced the use of screening mammograms in women ages 40-49 years. The authors noted that these recommendations, which were based on a detailed review of research, concluded that the harms of screening outweighed its benefits.

“The idea of using evidence to improve health care policy decisions enjoys [broad] support,” wrote the authors. Its implementation “can encounter greater resistance,” especially if it suggests that widely promoted technologies may not be worth the cost.

In their analysis, the authors examined the reasons behind the controversy and what it portends for CER. With this, they cite communications troubles in the way that the recommendations were developed and released into a “highly charged political environment” amidst broader societal concerns about government control of health care.

“Establishing broader support for the value of health services research, coupled with sustained efforts to communicate more effectively with the public, is crucial as the United States grapples with how best to improve the quality and efficiency of its health system,” Gusmano and Gray concluded.

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