Comparative effectiveness research in neurotrauma

Comparative effectiveness research (CER) is emerging as a commonly applied technique to determine the usefulness of medical interventions. Such research aims to compare various treatments for specific disease entities for overall effectiveness and potential for harm. According to the Centers for Disease Control, an estimated 1.7 million patients sustain a traumatic brain injury (TBI) annually in the US. In this review the authors examine the existence of CER reports in the area of neurotrauma to date and consider the context in which clinical research and evidence-based guidelines have and will continue to inform such analyses, with special attention to TBI.

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Editorial: The case for a comparative, value-based alternative to the patient-centered outcomes research model for comparative effectiveness research

Neurosurgical FOCUS ◽

10.3171/2012.5.focus12127 ◽

2012 ◽

Vol 33 (1) ◽

pp. E8 ◽

Cited By ~ 1

Author(s):

Nicholas F. Marko ◽

Robert J. Weil

Keyword(s):

Comparative Effectiveness Research ◽

Real World ◽

Outcomes Research ◽

Comparative Effectiveness ◽

Care Delivery ◽

Medical Decision ◽

Effectiveness Research ◽

Patient Centered ◽

The Us ◽

Overall Effectiveness

Considerable financial and human resources have been directed toward the emerging field of comparative effectiveness research (CER) in the US. Fundamentally, the concept of CER is so logical as to be almost self-evident; namely, that research regarding therapeutic strategies should go beyond efficacy and examine objectively their real-world effects and outcomes. In practice, however, reluctance to consider difficult questions related to the many dimensions of value in health care delivery and corresponding legislative constraints placed on the US CER enterprise risk limiting the ultimate utility of this investigative model. Significant constraints have been codified into the patient-centered outcomes research (PCOR) model of CER, which is emerging as the de facto method for conducting CER in the US. The experience of the authors as clinicians attempting to use CER to improve complex management decisions, for which multidimensional considerations of value represent a critical component of the overall effectiveness of alternate strategies, highlight the inability of PCOR to comprehensively inform this process. This suggests that PCOR may be a suboptimal approach for performing clinically relevant CER. In this editorial, the authors use clinical examples to highlight the limitations of the PCOR approach to CER and to propose an alternate approach, which they term “comparative, value-based effectiveness research” (CVER). The authors believe that the narrow scope and fundamental limitations of PCOR mitigate its overall value to medical decision-makers attempting to optimize overall effectiveness in the real-world setting, while a more comprehensive approach like CVER has greater potential to realize practical benefits for patients, clinicians, and society as a whole.

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Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence

Research and Theory for Nursing Practice ◽

10.1891/1541-6577.25.3.191 ◽

2011 ◽

Vol 25 (3) ◽

pp. 191-209 ◽

Cited By ~ 2

Author(s):

Maria C. Katapodi ◽

Laurel L. Northouse

Keyword(s):

Systematic Reviews ◽

Comparative Effectiveness Research ◽

Comparative Effectiveness ◽

Meta Analysis ◽

Research Question ◽

Alternative Methods ◽

Evidence Based ◽

Effectiveness Research ◽

Meta Analyses ◽

Research Studies

The increased demand for evidence-based health care practices calls for comparative effectiveness research (CER), namely the generation and synthesis of research evidence to compare the benefits and harms of alternative methods of care. A significant contribution of CER is the systematic identification and synthesis of available research studies on a specific topic. The purpose of this article is to provide an overview of methodological issues pertaining to systematic reviews and meta-analyses to be used by investigators with the purpose of conducting CER. A systematic review or meta-analysis is guided by a research protocol, which includes (a) the research question, (b) inclusion and exclusion criteria with respect to the target population and studies, © guidelines for obtaining relevant studies, (d) methods for data extraction and coding, (e) methods for data synthesis, and (f ) guidelines for reporting results and assessing for bias. This article presents an algorithm for generating evidence-based knowledge by systematically identifying, retrieving, and synthesizing large bodies of research studies. Recommendations for evaluating the strength of evidence, interpreting findings, and discussing clinical applicability are offered.

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