Evidence-Based Health Care Decision-making


To ensure high-quality care and the most efficient use of resources, clinicians and patients need to have the best possible evidence about the effectiveness of medical interventions. Research that compares treatment interventions and devices (comparative effectiveness research) can help determine what works best for particular patients. These studies are costly and may require financial support from the public. Consumers and other stakeholders should participate in the identification of research priorities and goals to ensure that public funds spent on comparative effectiveness research address areas of importance to them.

In 2009, the American Recovery and Reimbursement Act provided $1.1 billion for the Department of Health and Human Services, through the Agency for Healthcare Research and Quality and the National Institutes of Health (NIH), to conduct comparative effectiveness research. In 2010, the Affordable Care Act authorized the Patient-Centered Outcomes Research Institute, charged with identifying research priorities, establishing a national research agenda, conducting research, and disseminating research findings. The institute is required to conduct, support, and synthesize research related to the effectiveness and appropriateness of health services and procedures.

The Precision Medicine Initiative is a long-term research endeavor involving the NIH and other research centers. It aims to understand how a person's genetics, environment, and lifestyle can help determine the best approach to prevent or treat disease. This initiative will allow doctors and researchers to more accurately determine which treatment and prevention strategies for a particular disease will work in which groups of people. It is in contrast to a one-size-fits-all approach. In that approach, disease treatment and prevention strategies are developed for the average person with less consideration for the differences between individuals. The All of Us Research Program is a historic effort to gather data from one million or more people living in the United States to accelerate research and improve health. By taking into account individual differences in lifestyle, environment, and biology, researchers will uncover paths toward delivering precision medicine.



Evidence and decision-making

Congress should ensure adequate funding for research on the comparative effectiveness of treatment interventions, including prescription drugs, medical devices, and procedures. Research should apply to all health care settings and populations, including vulnerable groups. Funding also should support research to determine the most effective person- and family-centered care delivery approaches, including those intended to address the needs of people with multiple chronic conditions.