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ARRA Investments in Training: Comparative Effectiveness Research

Public Health Burden
A shortage of clinical researchers with sound training in Comparative Effectiveness Research (CER) was identified by several review groups including the CER group of the NIH funded Clinical and Translational Science Award (CTSA) program. As health care costs increase, growing importance has been attached to having clinical investigators skilled in comparative effectiveness research if we are to ensure that the nation secures the greatest benefit health care investments. ARRA funding provided two opportunities to expand the CER workforce that could draw on a pipeline of potential investigators with different levels of experience. Both opportunities were based on institutional “mentored career development” programs that provide Academic Health Centers (AHCs) with funds to support advanced training in specified fields.

Comparative Effectiveness Investment
Comparative effectiveness research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in “real world” settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.

The term “comparative” refers to comparisons of interventions and strategies to prevent, diagnose, treat, and monitor health conditions. The term “effectiveness” refers to real-world needs and decisions faced by patients, clinicians, and other decision-makers within “real-world settings,” i.e., not the ideal settings created in efficacy investigations. CER investigations compare two or more interventions and strategies that are currently available to practicing clinicians (i.e., not innovative or experimental drugs, devices, or approaches that might more typically be part of a Food and Drug Administration [FDA]-regulated efficacy study). These interventions and strategies can include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change, and delivery system strategies.

Mentored Career Development in CER
The National Center for Research Resources (NCRR) supports the Clinical and Translational Science Award (CTSA) Program. The program provides a collaborative and coordinated environment in Academic Health Centers (AHCs) that cater to the needs of diverse populations of scholars including (but not limited to) those with backgrounds in medicine, pediatrics, surgery, dentistry, nursing, allied health, pharmacology, health care administration and management, clinical research design, epidemiology, biostatistics, biomedical informatics, economics, quality improvement, modeling systems, ethics, behavioral science, engineering, and law. Training in clinical research at CTSAs is supported through mentorship of scholars by experienced investigators. This model has recently emerged as the most efficient in ensuring that the trainees are launched on a pathway to independent investigation. Academic Health Centers with CTSAs have a substantial number of experienced mentors in CER – so mentored career development programs are a highly effective pathway to expanding the workforce of health economists, clinicians, nurses, pediatricians and pharmacists (amongst others) to achieve the full health care impact of CER.
  • The scholar pool at CTSAs provides a rich source for future specialized CER specialists. A total of 19 Administrative Supplements were awarded to institutions with CTSAs to support the curriculum development, materials costs and scholar stipends for scholars. Each scholar has a 2-year period of training. Evaluation will become possible in 2013.
  • Demonstration projects use collaborations between academic health centers and community organizations or research networks that bring CER into community settings. For this project, the researchers will evaluate a rapid implementation of a medical home model on costs, patient acceptance, doctor acceptance, and impact on quality of care indicators. The model is supported by an open access technology. To assure quality of care and to gain widespread acceptance by primary care physicians, the researchers’ approach with the medical home / health information exchange strategy will accomplish several things that will impact public health: 1) overcome resistance in building secured health information exchanges, 2) support for broader acceptance of a medical home model, 3) improve analyses of patient outcomes to improve health care and medical systems.1

  1. 3TL1RR024158-05S1 - Clinical and Translational Award, GINSBERG, HENRY N (NY)
  2. 3KL2RR024149-05S1 - Clinical and Translational Award, MCPHERSON, DAVID D (TX)
  3. 3UL1RR024156-05S1 - Clinical and Translational Award, GINSBERG, HENRY N (NY)
  4. 3UL1RR024146-05S1 - Clinical and Translational Award, BERGLUND, LARS F (CA)
  5. 3UL1RR024148-05S1 - Clinical and Translational Award, MCPHERSON, DAVID D (TX)
  6. 3UL1RR024160-05S2 - Clinical and Translational Award, PEARSON, THOMAS ARTHUR (NY)
  7. 3UL1RR024153-05S1 - Clinical and Translational Award, REIS, STEVEN E (PA)
  8. 3KL2RR024980-04S1 - Clinical and Translational Award, ROSENTHAL, GARY E (IA)
  9. 3KL2RR024997-04S1 - Clinical and Translational Award, IMPERATO-MCGINLEY, JULIANNE L (NY)
  10. 3KL2RR024994-04S1 - Clinical and Translational Award, POLONSKY, KENNETH S (MO)
  11. 3UL1RR024979-04S1 - Clinical and Translational Award, ROSENTHAL, GARY E (IA)
  12. 3UL1RR024992-04S1 - Clinical and Translational Award, POLONSKY, KENNETH S (MO)
  13. 3UL1RR025014-04S2 - Clinical and Translational Award, DISIS, MARY L. (WA)
  14. 3UL1RR024996-04S1 - Clinical and Translational Award, IMPERATO-MCGINLEY, JULIANNE L (NY)
  15. 3UL1RR025752-03S1 - Clinical and Translational Award, SELKER, HARRY (MA)

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