Accelerating adoption of Comparative Effectiveness Research (CER) results with patient decision support interventions

The promise of comparative effectiveness research (CER) is that it will lead to improved clinical decision-making and better performance of the US healthcare system (REF). But whether CER can fulfill its potential and translate the results into evidence-based clinical decisions depends on adoption of CER results into daily practice. Decision support interventions (DESIs) that communicate CER results to patients have been shown to improve clinical decision making in clinical trials; however, additional work is needed to identify the most efficient ways of implementing DESIs so that CER results can inform routine clinical practice. Despite the growing evidence base supporting the use of DESIs, the implementation of these tools in routine clinical practice remains in its infancy. With grant support from the Foundation for Informed Medical Decision Making, the researchers have spent the past 4 years exploring various approaches to implementing DESIs in primary care practices. These efforts have highlighted two key issues in implementing DESIs: (1) ensuring that DESIs are provided to eligible patients by their healthcare teams, and (2) ensuring that patients review a DESI once it has been provided to them. We propose build on our extensive knowledge and experience to test alternative strategies for implementing DESIs in primary and specialty care in two geographically and structurally diverse health care systems – the Palo Alto Medical Foundation, a community-based multi-specialty care system (prime), and the University of North Carolina, Chapel Hill (subcontract), an integrated academic health care system. The goals of the proposed research are: (1) to test alternative approaches to distributing and increasing patient use of decision support interventions (DESI) for prostate cancer screening, and (2) to test the efficacy of a DESI for prostate cancer treatment.


Principal Investigator: Carmen Lewis, MD, MPH

Funding: Palo Alto Medical Foundation

Total Project Period: 09/01/2010-08/31/2013