cies filed by American families (Himmelstein et al., 2005). The Congressional Budget Office estimates that if left unchecked, health expenditures will rise to 25 percent of the gross national product by 2025 (CBO, 2007).

Developing and using information on which treatments work best for whom is imperative to achieving better value from national healthcare expenditures. Of the more than $2.5 trillion spent in 2009 on health in the United States, available estimates indicate that less than one-tenth of 1 percent has been devoted to such research (AcademyHealth, 2005; Moses et al., 2005). Recently, policy makers have demonstrated substantial interest in comparative effectiveness research (CER) (Jacobson, 2007), with attention and discussion focused on increased funding and on the structure, placement, and governance of an entity or agency charged with developing CER information (Kupersmith et al., 2005; Wilensky, 2006). With the passage of the American Recovery and Reinvestment Act of 2009, $1.1 billion were made available to the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), and the Secretary of Health and Human Services for the conduct of CER and to encourage data resource development and use for such analyses.1 These funds provided an important down payment on efforts to move to a system focused on delivering high-value care and driven by the best evidence, and formal recommendations have been made by the Institute of Medicine (IOM) (2009) and the Federal Coordinating Council for CER (FCC, 2009). With the 2010 passage of the ACA, and establishment of the Patient-Centered Outcomes Research Institute (PCORI), the capacity for sustained investment has developed. Appendices C, D, and E offer additional background.

The infrastructure needed to expand capacity for CER extends beyond developing data resources (e.g., registries, databases, data networks). Innovative research strategies are needed to improve the efficiency and relevance of clinical research as well as to ensure the appropriate translation and use of CER information by decision makers. Consideration is also needed of how best to align the substantial promise offered by health information technologies—to gather and disseminate needed data and information—with the needs of CER. These technologies offer opportunities to reduce costs and improve the quality of health care (e.g., e-prescribing, remote monitoring, public health records, electronic health records [EHRs]) and will increase access to new types of data and modes of communication (Litan, 2008). Adopting such innovations requires infrastructure development. Careful investments in the requisite workforce, systems, and technologies can also enhance the nation’s capacity to learn from health care delivered.

Consideration of such long-term strategies as well as the identification of areas where appropriate investment and coordination will enable

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1American Recovery and Reinvestment Act. 2009. HR1, 111th Cong, 1st Sess.



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