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Cross-national surveys should pay as much attention to the choice and compilation of aggregate-level contextual variables, as they do to individual-level dependent and independent variables relevant level-2 variables.

Social scientists contemplating or engaged in cross-national studies should be as open about their limitations as they are enthusiastic about their explanatory powers. The fact is that only certain subjects, and only certain aspects of those subjects, can successfully be measured cross-nationally.

Stringent and well-policed ground rules for comparable survey methods should become much more common in comparative studies than they are now.

To avoid infringing well-established cultural norms in one country or another, substantial national variations in methods are sometimes tolerated that should render comparisons invalid.

To transform cross-national surveys from parallel exercises into joint ones, collective development work, experimentation, scale construction, and piloting should be undertaken in all participating nations. One should routinely include methodological experiments in cross-national research. Analysts of cross-national data should try to suspend initial belief in any major inter-country differences they discover. All too often, such unexpected differences turn out to be impostors — the result of a poor translation, a subtly different show card, a variation in sampling coverage, or a particular cultural cue that subtly alters the meaning of the variable in that country.

As a result of the application of the above techniques, the VA system has modified practices to markedly improve both the process of health care delivery and its outcomes Jha et al. Nongovernmental CER Activities The private sector contains the life sciences industry, a number of orga- nizations with the capacity to conduct CER reviews, and some organizations focused on evidence development. However, not all of the work of these organizations meets the IOM definition of CER, and some of the work is pro- prietary, and available by contract or purchase, if at all.

Representative non- governmental organizations involved in CER are described briefly below. Life Sciences Industry Manufacturers of drugs, devices, and other medical products have made large investments in research on their products, motivated in part by regulatory requirements set by the FDA.

While most studies submitted to the FDA compare the new drug to a placebo, manufacturers also submit to the FDA studies comparing the new treatment to previously approved products with increasing frequency. Head-to-head studies may be necessary when comparison to a placebo is unethical, or to understand how the new treatment compares to an existing standard of care.

The latter may be used to influence the content of the package insert and subsequent marketing of the product.

Consequently, the FDA has been developing the standards and methods for comparative studies, and using the results to support the regulation of medical products.

Determination of safety and efficacy does allow entry into the market, but it does not ensure that a third-party payer will cover a product, or that safety and efficacy will be the sole basis for determining payment levels. Health care payers asked to pay a higher price for a new product increasingly require evidence that the higher price buys additional clinical benefit. For example, drugs with similar risk- benefit profiles may end up on different formulary tiers, depending on their price.

Its mission is to provide health care decision makers with scientifically rigorous assessments that synthesize the available evidence on the prevention, diagnosis, treatment, and manage- ment of disease.

Its assessments review the evidence that specific medical procedures, devices, and drugs improve health outcomes such as length of life, quality of life, and functional ability Blue Cross and Blue Shield As- sociation, Its re- ports are publicly available. Cochrane Collaboration Established in , the Cochrane Collaboration is an independent, multinational nonprofit organization that creates and distributes systematic reviews of health care interventions. These reviews are prepared by 52 Co- chrane Review Groups.

Quality standards, which are published regularly in a handbook, are maintained by editorial teams that oversee the prepara- tion and maintenance of the reviews. As of April , The Cochrane Database of Systematic Reviews contained a total of 5, systematic reviews of medical interventions, methodological studies, and diagnostic test accuracy Cochrane Collaboration, A number of smaller nonprofit and for-profit enterprises are actively involved in a variety of CER activities.

First, considerable CER is under way, often as a result of regulatory and reim- bursement incentives, with the support of a variety of programs in the public and private sectors. Although these programs vary in scope, goals, and activities, all seek to provide timely and useful evidence to health care decision makers on questions of patient care and policy significance.

In its report, the committee acknowledges that this is not an exhaustive descrip- tion of the activities of U. Even limiting itself to its description of federal CER activities and the study of systematic reviews in Knowing What Works in Health Care, the committee found consider- able duplicated effort, which is one reason to propose a mechanism to coordinate CER activities throughout the nation. New public investments in CER should complement these ongoing initiatives.

Federal coordination would allow for systematic identification and rapid dissemination of best practices, improved prioritization of research topics for future funding,. Second, leaders of CER must evaluate the present CER workforce in light of the requirements of an expanded, sustained program equal to the task of undertaking the priority research described in Chapter 5. For example, the size of the qualified CER workforce is not known and the workforce needed to perform CER must be defined, assessed, and trained.

Priorities for new CER must address the research infrastructure required to generate new data to answer questions of interest to patients and policy makers and must recommend investment in new capacity where needed. Third, the United States lacks a large-scale national infrastructure for learning from the delivery of health care through observational research using existing clinical and administrative data sources.

Moreover, a meth- odological framework is needed to guide the translation of clinical and policy relevant questions into answerable CER questions and to match CER questions to appropriate CER methods. Finally, the value of high-quality CER depends on successfully dissemi- nating and incorporating the results into routine practice. The means to the latter end include evidence-based guidelines, clinician and patient decision support tools, models of shared, informed decision making, reimbursement policy, and benefit design.

Conclusion Greater investment in CER has the potential to help improve the qual- ity, outcomes, and value of health care in America. But what exactly is CER? The committee has derived from several existing definitions six characteristics of CER studies, as well as a new working definition to guide priority setting.

CER is defined by the pragmatic aim of informing a specific health care or health policy decision, and the explicit comparison of clini- cally credible, alternative interventions in a representative study population. CER studies seek to inform population-level and subgroup-level decisions alike, using outcomes, methods, and data sources appropriate to answer.

CER en- compasses the collection of new experimental and observational data, the analysis of existing observational data, studies that synthesize completed research, and the translation and dissemination of research findings into clinical practice. Past clinical effectiveness studies have sought to answer questions about the effectiveness of medical interventions and strategies, but not all clini- cal effectiveness studies are comparative effectiveness studies.

CER studies compare the intervention under study against its best or most commonly used alternatives in practice or in development, rather than against a pla- cebo. Furthermore, the studies address effectiveness i. CER techniques are varied. Although RCTs, prospective cohort studies, and patient registries are among its most important tools, CER also uses other forms of information, such as systematic reviews, electronic health records, patient registries, and other observational datasets.

Prospective studies based on new trials or primary analyses of patient- level data are a very important aspect of CER. Pooled analyses are often critically important because they can be used to draw conclusions that could not be inferred from individual studies.

Besides helping health care providers and patients make better clinical decisions, CER information can improve care in other ways. For example, hospitals and health systems might organize their facilities and personnel to better support care that is revealed by CER to be superior.

For example, CER might assess the added value of using genomic information in addition to traditional clinical predictors to determine the best treatment for a cancer in a particular patient. It might suggest formal assessment of patient pref- erences in those situations in which patient and caregiver desires might.

These techniques might allow physicians to tailor therapy to reflect the goals and desires of each patient. Indeed, improvements in CER methods to support the use of targeted therapies are urgently needed. CER has been under way in a number of venues in the United States and has received notable support from the private and public sectors.

However, the incentives for doing primary CER are uneven, the infrastructure for supporting the development of new evidence is in an early stage of development, and a wide gap exists between CER results and their translation into consistent clinical practice and health policy. New federal investments in CER must address these infrastructure and translational priorities in addition to the information needs on specific clinical topics.

American College of Physicians. Improved availability of comparative effectiveness information: An essential feature for a high-quality and efficient United States health care system. Debate about funding comparative-effectiveness research. New England Jour- nal of Medicine Blue Cross and Blue Shield Association.

Technology Evaluation Center criteria http: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine Technological change and the growth of health care spending. United States Congressional Budget Of- fice. Morbidity and mortality weekly report. Methodological shortcomings predicted lower harm estimates in one of two sets of studies of clinical interventions.

Journal of Clinical epidemiology 60 1: Mission, vision and goals overview http: National health expenditures aggregate, per capita amounts, percent distribu- tion, and average annual percent growth, by source of funds: Selected calendar years http: Welcome to the Center for Medical Technology Policy http: Random reflections on health services.

Nuffield Provincial Hospitals Trust. Cochrane Collaboration consumer network http: Glossary of terms in the Cochrane Collaboration. Product descriptions-record counts http: Glucose control and vascular complications in veterans with type 2 diabetes. New England Journal of Medicine 2: Pioneering applied scientific research in healthcare https: AIDS, activism, and the politics of knowledge.

In Medicine and society. University of California Press. Bringing the DERP to consumers: Health Affairs 25 4: The implications of regional variations in Medicare spending. Health outcomes and satisfaction with care. Annals of Internal Medicine 4: New England Journal of Medicine 9: Beneficiary use of clinical preven- tive services.

Setting priorities for comparative effectiveness re- search. Paper presented at Implementing Comparative Effectiveness Research: Does comparative-effectiveness research threaten per- sonalized medicine? New England Journal of Medicine Pay for performance, quality of care, and outcomes in acute myocardial infarction.

Congress wants to restrict drug access: Wall Street Journal, January 20, Assessment of the scope and quality of clinical practice guidelines in lung cancer. Transforming healthcare with evidence http: How to do clinical practice research. Progress and challenges in evidence-based decision making. Health Affairs 24 1: Cochrane handbook for systematic reviews of interventions: The Cochrane Collaboration, Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: A collaborative analysis of individual patient data from ten randomised trials.

The Lancet Exploring comparative effec- tiveness: A randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Institute for Clinical and Economic Review. IOM Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century, Edited by J. Learning what works best: Knowing what works in health care: A roadmap for the nation. The National Academies Press. Optic nerve decom- pression surgery for nonarteritic anterior ischemic optic neuropathy NAION is not effective and may be harmful.

Effect of the transformation of the Veterans Affairs health care system on the quality of care. Comparative effectiveness research in the neurosci- ences.

Annals of Neurology 65 2: Journal of Clinical Oncology 25 6: A dictionary of epidemiology. Journal of the American College of Cardiology 53 Emerging methods in comparative effectiveness and safety: Symposium overview and summary. The quality of ambulatory care delivered to children in the United States. The quality of health care delivered to adults in the United States. Medicare Payment Advisory Commission. Report to the Congress: Reforming the de- livery system.

PGRN mission statement http: Oregon Health and Science University. Drug Effectiveness Review Project http: Research on the comparative effectiveness of medical treatments: Op- tions for an expanded federal role: These similarities and differences are identified through qualitative observation methods.

Additionally, some researchers have favored designing comparative studies around a variety of case studies in which individuals are observed and behaviors are recorded. The results of each case are then compared across people groups. Comparative research studies should be used when comparing two people groups, often cross-nationally. These studies analyze the similarities and differences between these two groups in an attempt to better understand both groups.

Comparisons lead to new insights and better understanding of all participants involved. These studies also require collaboration, strong teams, advanced technologies and access to international databases, making them more expensive. Use comparative research design when the necessary funding and resources are available. Do not use comparative research design with little funding, limited access to necessary technology and few team members.

Because of the larger scale of these studies, they should be conducted only if adequate population samples are available. Additionally, data within these studies require extensive measurement analysis; if the necessary organizational and technological resources are not available, a comparative study should not be used. Do not use a comparative design if data are not able to be measured accurately and analyzed with fidelity and validity.


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Comparative research is a research methodology in the social sciences that aims to make comparisons across different countries or cultures. A major problem in comparative research is that the data sets in different countries may not use the same categories, or define categories differently.

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"Comparative effectiveness research is the generation and synthesis of evidence generated through prospective and retrospective studies with either primary or .

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The major aim of comparative research is to identify similarities and differences between social entities. Comparative research seeks to compare and contrast nations, cultures, societies, and institutions. The comparative method is often used in the early stages of the development of a branch of science. It can help the researcher to ascend from the initial level of exploratory case studies to a more advanced level of general theoretical models, invariances, such as causality or evolution.

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“Comparative Effectiveness Research” is, in many ways, a new term for research that has gone on for decades under different labels. Comparative definition is - of, relating to, or constituting the degree of comparison in a language that denotes increase in the quality, quantity, or relation expressed by an adjective or adverb. How to use comparative in a sentence.