Ever-expanding health care costs have led to increased scrutiny of treatments and a new emphasis on value. In response, providers are seeking to improve clinical decision making by considering various factors, such as the effectiveness of different interventions, side effects, and how patients want to live their lives. Bringing these variables together is an example of the intersection of comparative effectiveness research and shared decision making between clinicians and patients.
Comparative effectiveness research allows healthcare professionals to compare different drugs, technologies, and care processes to ensure that they are best serving patients. Kaiser Permanente’s integrated health system, serving 10.1 million people across the nation, is uniquely suited for this kind of research. Michael Horberg, MD, MAS, one of the organization’s leaders in this space, discussed why this is true.
Michael Horberg, MD, MAS is the Executive Director of Research for Kaiser Permanente’s Mid-Atlantic Permanente Medical Group and Mid-Atlantic Permanente Research Institute
What role does an integrated health system with shared decision making like KP play in comparative effectiveness research?
Our goal is to conduct comparative effectiveness research on established processes or technologies to improve patient care.
The key aspects of clinical decision making are the patients’ wants, needs, aspirations, and their life stage. Research can always be very biological—for example, Drug A lowered blood pressure more than Drug B, so Drug A is superior—that doesn’t consider other factors, such as how often Drug A has to be taken. Drug A may be successful under ideal circumstances, but it may not produce the same effect in real-life situations, and FDA’s approval of a drug and patients’ willingness to take the drug don’t always align.
What’s important is synthesizing information for patients. In a non-integrated system, there isn’t a systematic way to make the decision between Drug A and Drug B. There is also not a method to weigh this data. In small fee-for-service practices, the doctors’ decisions may be based on a small sample of patients or lobbying by drug companies. At KP, we can collect information from a large sample of patients without industry influence and make more well-informed decisions.
Many stakeholders believe that comparative effectiveness research will have a moderate to substantial impact on healthcare decision making in the next five years. Where do you see it by 2020?
Comparative effectiveness is going to be critical, especially as patients become more engaged in care and more drugs, technology, and care processes become available.
Because patients are the center of care, we will see more talk about how to bring them into the decision making process and into research. A lot of the questions research scientists think are very clear in our minds can be broadened by incorporating patients’ perspectives.
We will also start to see a lot of people and organizations talking about the effectiveness of different technologies and practices. For example, in pharmaceuticals, we will see more studies comparing generic medications and branded prescriptions, as well as comparing different branded drugs. As we observe just minor gradations of improvement of one product over a previous product, people will start asking about the significance and magnitude of the added benefit or if there is any extra value at all.
To learn more about comparative effectiveness research at KP, please see the pages for the Mid-Atlantic Permanente Research Institute and the Center for Effectiveness and Safety Research.
