Thus, studies must have appropriate comparison group to determine the effectiveness of a new intervention. Studies must be adequately powered so that the conclusion can be drawn with confidence,

both statistically and clinically. Retrospective studies, while aided by the progressive availability of electronic medical records for large numbers of patients, are often limited by biases or confounders that limit the reliability of data. As a result, it is critical that research strategies incorporate plans to match specific study methodologies to the question being asked and to the population and/or database that is available. Close attention must be paid to accounting for potential biases and adjusting for confounding factors. Recommendations have been made in the IOM report to use electronic health registries and databases for particular AZD1208 types of AUY-922 CER where these study designs may be well-suited to answer specific questions about diagnostic tests and treatments. Finally, it is imperative that the investigators have rigorous

training in epidemiological research, health services research, and statistical methods to ensure methodological robustness and study validity. Additional resources are necessary such as new research infrastructure to answer clinical and policy questions as well as develop and test innovative methodologic frameworks. Future initiatives from NIH and the Agency for Healthcare Research and Quality are expected to involve requests for proposals to develop CER-mentored training programs to expand the pool of qualified investigators in this field.

The recent emphasis on CER should not be regarded as a mandate that all patient-oriented research must focus on comparative effectiveness or even effectiveness. Naturally, for early phase studies of an intervention, it is critical to evaluate their safety and efficacy under a defined set of circumstances. Once an intervention has been shown to be efficacious, CER selleck products to address effectiveness in settings different from the efficacy studies may inform physicians, patients, and policy makers. Ultimately, in order for CER to impact health care delivery or outcomes, the results must be communicated effectively to patients and providers and integrated into the health care delivery system. Although the traditional model of biomedical research has devoted considerable attention and resources to developing new therapies, enhancing the potential benefits of what we already have and improving nonmedical or health system factors has not been studied in depth. CER recognizes that both types of research are crucial in our quest to improve the health of patients.