Comparative Effectiveness Research

Powerful Patient, 2009 Week 9

Host: Joyce Graff, http://powerfulpatient.org, editor@vhl.org 800-767-4845

Beginning February 23, 2009 Listen Program guide for this show

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Joyce speaks with Andrew Sperling, a member of the Steering Committee of the Partnership to Improve Patient Care, about the new funding for Comparative Effectiveness Research in the newly passed Stimulus Bill.

About Our Guest

Andrew Sperling is the Director of Federal Legislative Advocacy for NAMI, the National Alliance on Mental Illness.  In this position, he leads NAMI’s legislative advocacy initiatives in Congress and before federal agencies. Mr. Sperling works on issues affecting the mental health community with a focus on improving the lives of people with severe mental illnesses.

See his biography at
http://www.nami.org/Template.cfm?Section=Bios1&template=/ContentManagement/ContentDisplay.cfm&ContentID=31151

About the Stimulus Bill

There is a great deal of incorrect information in the press about the Stimulus Bill.  The three hottest items seem to be the Office of the National Coordinator for Health Information, the discussion of support for the implementation of electronic records, and the money allocated for Comparative Effectiveness Research.

The office of the National Coordinator of Health Information is not new -- this is a position that was created by President G. W. Bush in his second term, by Executive Order. In the current bill that person is assigned the task of overseeing the conversion from paper systems to electronic system at hospitals and clinics throughout the United States. This office has no influence over the decisions made by doctors, it is entirely to do with implementing computerized systems in hospitals and clinics, in an effort to improve patient care, lower the risk of errors, and make sure that systems throughout the United States can work together. 

Banks went through this conversion forty years ago. Banking information was standardized, computers were taught to work together. This interworking has brought us ATM machines, online banking, and a number of other services that have increased our flexibility and convenience. Automated banking procedures have reduced costs, increased the speed, and lowered the risk of errors. If we can trust our banking information to secure networking, we should also be able to trust our medical information to secure networking. Clearly it has to be done carefully and in a standardized way, which is what this office is to ensure. This office will direct how these funds are used and implementations are done to improve outcomes.

 There are two primary areas of focus in the current efforts to improve health care:

• Access to health care
• Quality of health care

Both political parties are very much aware that inaction is no longer tenable.

The Actual Bill

The actual bill as agreed by both House and Senate is online
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.1.enr:

The section on Healthcare Research and Quality begins here:
http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111O4hwcf:e186748:

Comparative Effectiveness Research

The Federal Coordinating Council for Comparative Effectiveness Research (CER) will coordinate CER and determine what research is needed. This would not be the entity conducting the research. The bill allows for CER research to be done through the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) through existing authorities. An early House Appropriations Committee Report stated that the least effective, most effective treatments “would not be prescribed.” This language caused a lot of problems, and work was done to change that language before the bill was passed.  The final bill does not include such statements.  Rather it focuses the research on clinical comparative effectiveness.

The Coordinating Council has 60 days within which to contract with the Institute of Medicine (IOM) to set priorities and do the research.

The Institute of Medicine is an independent non-profit agency serving as adviser to the nation to improve health.
Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The mission of the Institute of Medicine embraces the health of people everywhere. 

You can Have a Voice in this Process

Agency for Healthcare Research & Quality (AHRQ) - http://www.ahrq.gov/
Institute of Medicine (IOM) -  http://www.iom.edu
Partnership to Improve Patient Care (PIPC) - http://www.improvepatientcare.org/

Stay in touch with your Senators and Representative in Washington.  Every American has three Members of Congress who are their principal advocates in Washington.  To find their names and contact information,

• U.S. Senate = http://www.senate.gov
• U.S. House of Representatives = http://www.house.gov

Call your Members of Congress and ask to speak with their Health Care staffers.  These staff members are very knowledgeable about the issues and can help you understand the position your Member of Congress is taking at the moment, and give you an opportunity to write a letter or meet in person with that person.  They want to hear from their constituents, and understand your concerns, so that they can represent your interests.