PCORI & CER Agencies
Given the billions of dollars in funding for comparative effectiveness research (CER) in the United States, it is helpful for health care decision-makers and researchers to understand how the research is prioritized, conducted, shared and applied in the United States. An integral part of this research is stakeholder and decision-maker engagement from the start to finish of this process.
Below are several organizations that are taking a primary role in the conduct of this research.
Patient-Centered Outcomes Research Institute. The Affordable Care Act, the health reform legislation signed into law in March 2010, established the Patient Centered Outcomes Research Institute (PCORI), a private, non-profit corporation empowered to develop and fund CER. PCORI and its activities are governed by an independent, 21-member board of governors that includes the director of the Agency for Healthcare Research and Quality and the director of the National Institutes of Health, with the remaining members appointed by the U.S. Comptroller General. PCORI also receives input from a standing methodology committee and several permanent and ad-hoc expert panels. PCORI's activities are supported by contributions from both public and private funds made available to the institute through a Patient-Centered Outcomes Research Trust Fund.
Agency for Healthcare Research and Quality (AHRQ). AHRQ was established in 1989 as the Agency for Healthcare Policy Research. Reauthorization legislation in 1999 established AHRQ as the lead federal agency charged with supporting research designed to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
Like PCORI, AHRQ has a broad set of stakeholders, including clinicians and health care providers, consumers and patients, health care policymakers, purchasers and payers, and other health experts. AHRQ’s authority has expanded to generate new knowledge through a network of research centers and private-public partnerships. In 2005, AHRQ launched its Effective Health Care Program (EPC). The EPC's core mandate is to review and synthesize existing knowledge through 12 Evidence-based Practice Centers (EPCs). EPCs undertake systematic reviews of currently available evidence concerning various topics including clinical medicine, social and behavioral science, and economics.
U.S. Preventive Services Task Force
U.S. Preventive Services Task Force (USPSTF), first convened in 1984 and sponsored by AHRQ since 1998, is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of Americans by making evidence-based recommendation about clinical preventive services. USPSTF aims to evaluate the benefits of individual treatments and services based on age, gender, and disease risk factors, making recommendations about which treatments or services should be encouraged in primary medical care and for which populations. AHRQ provides administrative, research, technical, and communication support to USPSTF. New members of USPSTF’s 16-person panel are selected by the Director of AHRQ.
Private CER efforts include:
- Cochrane Collaboration: Founded in 1993, this global non-profit network is dedicated to evaluating health care interventions through systematic reviews. The major product of the Collaboration is the Cochrane Database of Systematic Reviews, which is published quarterly as part of The Cochrane Library.
- Blue Cross/Blue Shield Technology Evaluation Center: Established in 1995, this entity reviews interventions and evidence to determine effectiveness and guide clinical decision making.
- Center for Medical Technology Policy (CMTP): CMTP was established as an independent non-profit 501(c)(3) organization in January 2008 in order to improve the quality, relevance, and efficiency of health care research. Initial funding was provided by the California Healthcare Foundation and the Blue Shield of California Foundation, with ongoing funding from organizations including the National Pharmaceutical Council.
- Institute for Clinical and Economic Review (ICER): This organization was created by a grant from the Blue Shield of California Foundation in 2006, and produces appraisals of clinical effectiveness and cost effectiveness of medical innovations. ICER works with all stakeholders to develop and evaluate applications of evidence to create innovative patient-clinician decision support tools, insurance benefit designs, and coverage and payment policies.Ongoing funding is provided by a group of organizations, including the National Pharmaceutical Council.
- ECRI Institute (formerly the Emergency Care Research Institute): ECRI Institute is a non-profit agency and is a Collaborating Center of the World Health Organization (WHO), and an Evidence-based Practice Center (EPC) for AHRQ. ECRI evaluates safety, quality, and cost-effectiveness in health care. It offers more than 10 databases, publications, information services, and technical assistance services.
- Hayes, Inc: This independent organization specializes in health technology assessment reports for health care organizations, including health plans, managed care companies, hospitals, and health networks. Hayes’ medical research analysts assess such technologies as medical and surgical procedures, drugs, biologics, diagnostic and screening tests, medical devices and equipment, and complementary and alternative therapies.
- Oregon Drug Effectiveness Review Project: Established in 2003, this project “produces systematic, evidence-based reviews of the comparative effectiveness and safety of drugs in many widely used drug classes, and applies the findings to inform public policy and related activities in local settings.”