Medical care
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Defining comparative effectiveness research (CER) was the first order of business for the Institute of Medicine Committee on Initial Priorities for CER. The Institute of Medicine committee approached the task of defining CER by identifying the common theme in the 6 extant definitions. The definition follows: "Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. ⋯ Defining CER requires us to decide what we want from decisions about health care. Definitions also serve a bureaucratic function: they can set boundaries that delineate which research is eligible for CER program funding. Definitions--and the funding that advances their goals--can reshape the research environment.
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Comparative effectiveness research analyzes groups of patients and looks for associations between medical treatments and patient outcomes. To make meaningful comparisons of medical interventions, one must consider clinical heterogeneity of patient populations, intervention combinations, and outcomes. ⋯ PBE study designs address comparative effectiveness by creating a comprehensive set of patient, treatment, and outcome variables, and analyzing them to identify treatments associated with better outcomes for specific types of patients. PBE studies are an alternative to randomized controlled trials, well suited to determine what works best for specific patient types, and provide clinicians with a rational basis for treatment recommendations for individual patients. They provide a holistic picture of patients, treatments, and outcomes, with no preset limits to the number of variables that can be included. Such an approach is needed for high quality comparative effectiveness research.
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The modifications introduced to the inpatient prospective payment system on October 1, 2008, to disallow payment for 8 secondary conditions, if not present on admission (POA), constitute a significant shift that is expected to be followed by similar steps by private payers. ⋯ The estimates provided in this study should enable hospitals to identify how improvements in care can also result in cost savings. Focusing this study on CC cases enables hospitals to address highest cost cases that consume crucial resources in their CC settings.