Introduction to CER/PCORweb2.facs.org/ORC2014Flashdrive/MATERIALS/...CER is the generation and...
Transcript of Introduction to CER/PCORweb2.facs.org/ORC2014Flashdrive/MATERIALS/...CER is the generation and...
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Introduction to CER/PCOR
Farhood Farjah, MD MPH Assistant Professor of Surgery
University of Washington
Division of Cardiothoracic Surgery Surgical Outcomes Research Center
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Disclosures
• None
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Acknowledgments
• Diana S.M. Buist, PhD • Senior investigator • Group Health Research Institute
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Outline
• CER • Randomized studies • Observational studies
• PCOR
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Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
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Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
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Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
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Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
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Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
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Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
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Tammemägi, NEJM, 2013
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GHC
KPSC
KPCO
KPHI
GHS
0 6 12 18 24 30
MC
36
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Observational studies
• Generalizability • Clustering • Confounding • Causality
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Confounder
Intervention Outcome
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Intervention
Process or Event
Outcome
Confounder
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Specialty
Staging & Treatment
Survival
Confounders
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Confounders Intervention
Outcome Intervention
Adjusted for propensity
Estimate propensity of receiving an intervention
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Weintraub, NEJM, 2012
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Confounders
Intervention
Outcome
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Confounders
Intervention
Outcome
Instrument X
X
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Baiker, NEJM, 2013
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Confounders
Medicaid
Outcome
Lottery X
X
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Causality—Bradford Hill Criteria • Strength • Consistency • Specificity • Temporality • Biological gradient • Plausibility • Coherence • Experimental evidence • Analogy
Rothman, Am J Public Health, 2005
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Patient-centered outcomes research (PCOR)
• CER with the patient’s voice as a centerpiece
• Stakeholder engagement
Selby, JAMA, 2012
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Patient-centered outcome
• Health-related outcomes that are important to patients
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Cykert, CHEST, 2000
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Patient-reported outcome (PRO)
• An outcome that only the patient can report
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Teeter, CHEST, 1998
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PRO
• Concepts and domains • Instruments • Disease-specific versus generic • Validity • Reliability • Responsiveness • Cultural/language adaptation