Comparative effectiveness research in the era of health reform.

NC Med J May/June 2010, Volume 71, Number 3 A lthough the provisions of the recently passed health reform bill (the Patient Protection and Affordable Care Act) addressing access to health insurance have received the most publicity, a critical component of the package of initiatives will certainly affect the way clinicians practice medicine, the way care will be organized, and potentially the way health care will be reimbursed. Many of these provisions are contained under the broad rubric of “comparative effectiveness research” (CER). Comparative effectiveness research is nothing new. Clinicians have always compared treatments with each other. We want to provide our patients with the best treatments available, taking into account issues of convenience, relative benefits, relative harms, cost, and accessibility. The marked increase and interest in CER over the past several years is the result of several existing forces: