Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care
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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 WORDScomparative effectiveness evidence-based medicine health technology assessment quality of health care cost-effectiveness health information technology organizational decision making
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.
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