PHYSICIAN PREFERENCES FOR THE CONDUCT AND PRESENTATION OF COMPARATIVE EFFECTIVENESS RESEARCH

Purpose: It is important to understand not only prioritizing and rigorously conducting Comparative Effectiveness Research (CER), making CER findings accessible to physicians and applicable to practice. This study assessed physicians' stated preferences for the conduct, content and presentation of CER.

Method: Literature review and semi-structured interviews identified domains and guided survey design. The survey included questions on how physicians access clinical information, what they consider key aspects of CER, how they value and trust CER from various sources, perceived barriers to implementation, and suggestions for dissemination.

Result: Interviews were conducted with 17 physicians encompassing GIM, family medicine, surgery, rheumatology, infectious disease and cardiology. Surveys were completed by 279 practicing physicians in the same specialties. Interviews reflected concerns that CER would negatively impact practice, despite consensus that CER was important and relevant to patient care. Most interviewees expressed the importance of unbiased sources funding and conducting CER. There was also agreement on the need for directed dissemination strategies, although specific suggestions varied. Of note, 171/279 respondents said they had not heard of CER prior to the survey. The most valued information sources were reported as colleagues (96%), journals (89%) and professional societies (81%). Over 75% of respondents considered all characteristics (from IOM, PCORI and AHRQ definitions) central to CER versus other clinical research. There was also consensus about funding and conducting CER, with >80% of respondents trusting information from the NIH, AHRQ, PCORI, CDC, academic centers, and professional societies in general, compared with ~60% for the AMA, 30% for consumer organizations, and 15% for insurance companies and drug/device companies. Dissemination methods considered high value by >75% of respondents were peer-reviewed journals, CER summaries in clinical journals, and UpToDate type information, but 30-50% of respondents viewed all other presented options as high-value (CER.gov website, CER online library, society emails, toolkits, integration into EMR, CME, opinion leaders).

Conclusion: Despite the focus on CER from the research and policy community, many practicing physicians are unaware of it. Those who are aware feel that it is important, but see barriers to implementation. It will be important that CER be conducted by trusted entities and that equal effort be expended on dissemination as on the quality of the research if CER is to reach its goal of improving health care quality.