the effectiveness and value of health care, the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care convened a workshop on July 30–31, 2008, titled Learning What Works: Infrastructure Required for Comparative Effectiveness Research. Box S-1 describes the issues that motivated the meeting’s discussions: the substantial and growing interest in activities and approaches related to CER; the lack of coordination of key activities, such as the selection and design of studies, synthesis of existing evidence, methods innovation, and translation and dissemination of CER information; shortfalls and widening gaps in the workforce needed in all areas of CER; the opportunities presented by the recent calls for expanded resources for work on the comparative effectiveness of clinical interventions; the growing appreciation of the infrastructure needed to support this work; and the need for a trusted, common venue to identify and characterize the need categories, begin to estimate the shortfalls, consider approaches to addressing the shortfalls, and identify priority next steps.

BOX S-1
Issues Motivating the Discussion

  1. Substantial demand for greater insights into the comparative clinical effectiveness of clinical interventions and care processes to improve the effectiveness and value of health care.
  2. Expanded interest and activity in the work needed—e.g., comparative effectiveness research, systematic reviews, innovative research strategies, clinical registries, coverage with evidence development.
  3. Currently fragmented and largely uncoordinated selection of studies, study design and conduct, evidence synthesis, methods validation and improvement, and development and dissemination of guidelines.
  4. Expanding gap in workforce with skills to develop data sources and systems, design and conduct innovative studies, translate results, and guide application.
  5. Opportunities presented by the attention of recent initiatives and the increasing possibility of developing an entity and resources for expanded work on the comparative effectiveness of clinical interventions.
  6. Growing appreciation of the importance of assessing the infrastructure needed for this work—e.g., workforce needs, data linkage and improvement, new methodologies, research networks, technical assistance.
  7. Desirability of a trusted, common venue to identify and characterize the need categories, begin to estimate the shortfalls, consider approaches to addressing the shortfalls, and identify priority next steps.


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