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Journal of General Internal Medicine

, Volume 25, Issue 12, pp 1352–1355 | Cite as

Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care

  • Craig A. UmscheidEmail author
  • Kendal Williams
  • Patrick J. Brennan
Perspectives

Abstract

Hospital-based comparative effectiveness (CE) centers provide a model that clinical leaders can use to improve evidence-based practice locally. The model is used by integrated health systems outside the US, but is less recognized in the US. Such centers can identify and adapt national evidence-based policies for the local setting, create local evidence-based policies in the absence of national policies, and implement evidence into practice through health information technology (HIT) and quality initiatives. Given the increasing availability of CE evidence and incentives to meaningfully use HIT, the relevance of this model to US practitioners is increasing. This is especially true in the context of healthcare reform, which will likely reduce reimbursements for care deemed unnecessary by published evidence or guidelines. There are challenges to operating hospital-based CE centers, but many of these challenges can be overcome using solutions developed by those currently leading such centers. In conclusion, these centers have the potential to improve the quality, safety and value of care locally, ultimately translating into higher quality and more cost-effective care nationally. To better understand this potential, the current activity and impact of hospital-based CE centers in the US should be rigorously examined.

KEY WORDS

comparative effectiveness evidence-based medicine health technology assessment quality of health care cost-effectiveness health information technology organizational decision making 

Notes

Acknowledgements

We thank our colleagues Jalpa A. Doshi, PhD, Matthew D. Mitchell, PhD, David Goldmann, MD, and Brian Leas, MA, MS at the University of Pennsylvania for reviewing multiple versions of this manuscript and for their many thoughtful suggestions. No specific sources of funding were used.

Conflict of Interest

Drs. Umscheid and Williams co-direct a hospital-based comparative effectiveness center at the University of Pennsylvania Health System. Dr. Umscheid is also a member of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), which uses evidence reports developed by the Evidence-based Practice Centers of the Agency for Healthcare Research and Quality. Dr. Brennan established a hospital-based comparative effectiveness center in his role as the Chief Medical Officer of the University of Pennsylvania Health System.

References

  1. 1.
    Gawande A. The Cost Conundrum. The New Yorker. 2009 June 1.Google Scholar
  2. 2.
    Cicchetti A, Marchetti M, Dibidino R, Corio M. Hospital based HTA worldwide: the results of an international survey. Health Technology Assessment International Web site. Available at: http://www.htai.org/fileadmin/HTAi_Files/Conferences/2008/Files/Sessions/Presentation_Marco_Marchetti.pdf Accessed July 21, 2010.
  3. 3.
    Davis K. Slowing the growth of health care costs–learning from international experience. N Engl J Med. 2008;359(17):1751–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Fuchs VR. Three "inconvenient truths" about health care. N Engl J Med. 2008;359(17):1749–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Clancy CM, Cronin K. Evidence-based decision making: global evidence, local decisions. Health Aff (Millwood). 2005;24(1):151–62.CrossRefGoogle Scholar
  6. 6.
    Health technology assessment. Int J Technol Assess Health Care. 2009;25 Suppl 1:10.Google Scholar
  7. 7.
    Federal Coordinating Council for Comparative Effectiveness Research. Report to the President and Congress on Comparative Effectiveness Research. Washington, D.C.; June 2009.Google Scholar
  8. 8.
    Atkins D, Fink K, Slutsky J. Better information for better health care: the Evidence-based Practice Center program and the Agency for Healthcare Research and Quality. Ann Intern Med. 2005;142(12 Pt 2):1035–41.PubMedGoogle Scholar
  9. 9.
    Slutsky JR, Clancy CM. AHRQ's effective health care program: why comparative effectiveness matters. Am J Med Qual. 2009;24(1):67–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Health Reform. Kaiser Family Foundation Web site. Available at: http://www.kff.org/healthreform/sidebyside.cfm Accessed July 21, 2010.
  11. 11.
    VanLare JM, Conway PH, Sox HC. Five next steps for a new national program for comparative-effectiveness research. N Engl J Med. 2010;362(11):970–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care. 2010;26(3):294–300.CrossRefPubMedGoogle Scholar
  13. 13.
    Bodeau-Livinec F, Simon E, Montagnier-Petrissans C, Joel ME, Fery-Lemonnier E. Impact of CEDIT recommendations: An example of health technology assessment in a hospital network. Int J Technol Assess Health Care. 2006;22(2):161–8.CrossRefPubMedGoogle Scholar
  14. 14.
    McGregor M. Impact of TAU Reports. Vol. 2009: Technology Assessment Unit of the McGill University Health Centre Web site. Available at: http://www.mcgill.ca/tau/publications/2008/. Accessed July 21, 2010.
  15. 15.
    Mayes R. The origins, development, and passage of Medicare's revolutionary prospective payment system. J Hist Med Allied Sci. 2007;62(1):21–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Blumenthal D. Launching HITECH. N Engl J Med. 2010;362(5):382–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Luce BR, Brown RE. The use of technology assessment by hospitals, health maintenance organizations, and third-party payers in the United States. Int J Technol Assess Health Care. 1995;11(1):79–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Weingart SN, Weingart SN. Acquiring advanced technology. Decision-making strategies at twelve medical centers. Int J Technol Assess Health Care. 1993;9(4):530–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Mitchell MD, Anderson B, Williams K, Umscheid CA. Systematic review of heparin flushing and other interventions to maintain patency of central venous access devices. J Adv Nurs. 2009;65(10):2007–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Stetler C, Mittman B, Francis J. Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series. Implement Sci. 2008;3:8.CrossRefPubMedGoogle Scholar
  21. 21.
    Dougherty D, Conway PH. The "3T's" Road Map to Transform US Health Care: The "How" of High-Quality Care. J Am Med Assoc. 2008;299(19):2319–21.CrossRefGoogle Scholar
  22. 22.
    Conway PH, Clancy C. Charting a Path From Comparative Effectiveness Funding to Improved Patient-Centered Health Care. J Am Med Assoc. 2010;303(10):985–6.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Craig A. Umscheid
    • 1
    • 2
    • 3
    Email author
  • Kendal Williams
    • 1
    • 3
  • Patrick J. Brennan
    • 3
    • 4
  1. 1.Center for Evidence-based PracticeUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Office of the Chief Medical OfficerUniversity of PennsylvaniaPhiladelphiaUSA

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