Spending limited health care dollars on what works best: the promise of comparative effectiveness research.

NC Med J May/June 2010, Volume 71, Number 3 developed, which involved strengthening the compressed bone through injection of cement. Case series studies that were restricted to a before-after comparison of patient outcomes demonstrated that they felt much better after the injection. Over 1,000 patients per year received this treatment in North Carolina. It was not until the summer of 2009 that randomized trials demonstrated that the level of improvement in patient well-being was similar whether they received the cement injection or a sham injection of lidocaine.8 There is still a great deal that we don’t know about vertebroplasty. It remains possible that some subsets of patients may benefit from the treatment, but lack of information for almost a decade exposed many patients to a treatment of essentially unknown efficacy that also carries some risk. Well-conducted trials 10 years ago might have led to much better current information about treatment options for patients and providers. How are we to avoid the fate of CER studies winding up on a shelf or in a library? Physicians are exposed to hundreds of research articles each week. Dissemination of the highest quality information in an unbiased fashion will be critical if CER is to positively affect care patterns in the US. Past federal efforts have been on a relatively small scale and dissemination efforts have been disappointing to date. However, funding from the American Recovery and Reinvestment Act (ARRA) stimulus bill and especially the new health reform legislation will significantly increase the visibility of CER. This will include not only peer-reviewed journal articles but also direct dissemination of results to providers and patients. Combining CER information with electronic health records is an obvious extension of these joint efforts. The challenge of providing information to physicians and patients in a convenient format, at a time close to the provision of Spending Limited Health Care Dollars on What Works Best: The Promise of Comparative Effectiveness Research