Marian Benjamin

Comparative effectiveness research (CER) has received $1.1 billion in support as part of the American Reinvestment and Recovery Act of 2009 (ARRA). It is not without controversies, one of which is the fear that this will end up being cost-effectiveness research, with health care being rationed and the least expensive treatments being dictated. A letter to legislators posted on the Alliance for Patient Access by a group of national associations,1 including AARC, expressed this concern, urging that the funding should be “used only to support clinical comparative effectiveness research.”

Authors of an editorial in the May 7, 2009, issue of the New England Journal of Medicine2 state that, although the Federal Coordinating Council for Comparative Effectiveness Research (the body in charge of seeing that the research is carried out) “will not recommend clinical guidelines for payment, coverage, or treatment,” some are concerned that treatments will be reimbursed based on cost-benefit calculations.

These authors also expressed another concern—that CER might jeopardize personalized medicine. They write: “The controversy stems in part from a perceived contradiction between the concepts of CER and personalized medicine. In CER, groups of patients are analyzed to compare the effectiveness of alternative medical strategies. … Personalized medicine, [however], suggests an approach to care that is based on individuals rather than groups.”

Could this be an opportunity for respiratory therapists? Lee Guion, MA, RRT, respiratory therapist at the Forbes Norris MDA/ALS Research Center in San Francisco, and the author of Respiratory Management of ALS, published by Jones and Bartlett in 2009, says yes. She claims that many of the treatment choices respiratory therapists make are based only on what’s always been done and not necessarily because it has been proven to be most effective.

This could be a perfect time for respiratory therapists to do some real research and come up with evidence-based procedures, based on clinical trials. In fact, the American Thoracic Society urges physicians, researchers, and other health professionals “to lead the development of comparative effectiveness research agendas and priorities at the NIH and AHRQ to ensure that such research improves patient outcomes.”3

The Department of Health and Human Resources defines CER as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care.” Respiratory therapists are uniquely placed to compare treatment options. Read the article by McCoy et al4 in the August issue of RT to see an example of how respiratory therapists can collaborate on research. Listen to our August podcast on ventilatory modes5 and hear how a respiratory therapist in Virginia is in phase 2 of a trial of neurally adjusted ventilatory assist (NAVA) and how another in Utah is questioning the conventional wisdom of the ARDSnet protocol for mechanical ventilation.

Maybe you have an idea, but no research experience. Guion suggests approaching a colleague who has such knowledge and can help you get started. Or get on the Web with people you know at other facilities and brainstorm. AARC members can access guidelines for research and/or join a research roundtable.

Now is the time to take preemptive steps to ensure that the treatment choices you are given in the future truly reflect the best care for your patients—personalized to their own needs.

—Marian Benjamin
[email protected]

References

  1. Letter from concerned groups on comparative effectiveness funding in H.R. 598, January 26, 2009. Available at: [removed]www.allianceforpatientaccess.org/090126%20cer%20ltr.pdf[/removed]. Accessed August 3, 2009.
  2. Garber AM, Tuni SR. Does comparative effectiveness research threaten personalized medicine? Available at: content.nejm.org/cgi/content/full/360/19/1925. Accessed August 3, 2009.
  3. American Thoracic Society. Health Care Reform Fact Sheet. Available at: [removed]www.thoracic.org/sections/about-ats/advocacy/resources/health-care-reform.pdf[/removed]. Accessed August 4, 2009.
  4. US Department of Health and Human Services. Draft Definition, Prioritization Criteria, and Strategic Framework for Public Comment. Available at: [removed]www.hhs.gov/recovery/programs/cer/draftdefinition.html[/removed].
  5. McCoy R, Eiken T, Diesem R. APAP: performance variables may impact therapy. RT: For Decision Makers in Respiratory Care. 2009;22(8):24.
  6. Ventilatory Modes Podcast. Available at: www.respiratory-therapy.com/modes.