The US Department of Health and Human Services has defined comparative effectiveness research (CER) as “the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions.” Although this is a broad definition, HHS notes that the “purpose of this research is to inform patients, provider and decision-makers, responding to their expressed needs about which interventions are most effective for which patients under specific circumstances.”
The definition and purpose set by HHS emphasizes patients and their preferences. The Radiology Alliance for Health Services Research (RAHSR) had devoted special issues of Academic Radiology to patient-centered radiology, including ways to improve communication and care delivery, emphasizing patients’ preferences . In many ways, communicating with patients represents the biggest challenge to imagers in the provision of patient-centered imaging care. Nonetheless, the American College of Radiology has initiated its Face of Radiology campaign, designed to improve the profile of radiology to its ultimate consumers, patients .
To continue to enhance radiologists’ contribution to clinical care, we need to leverage what we do best by creating informatics infrastructure to enable the delivery of patient-centered care and to facilitate CER in the assessment the value of imaging by radiologists . We need to generate the evidence that informs policy decisions using evidence-based techniques broadly applied to clinical questions in imaging as well as develop new research methods to assess patient-centered outcomes that fully reflect our contribution to clinical care .
Continuing on the theme of CER in imaging, the current RAHSR issue presents four new articles. In the interest of teaching our residents, future radiology practitioners, the skills to assess CER in the literature and deliver evidence-based care, Kelly et al describe their institution’s experience with a resident-run evidence-based radiology journal club. Bresnahan critically evaluates the economic analysis literature in oncology to understand the quality of the evidence. Reichman et al validate a new reference standard for the diagnosis of vasospasm. Gold et al present a thought-provoking piece on issues of validating a reference standard.
We will continue to face limits on utilization and be required to justify imaging use using evidence-based methods. RAHSR will continue to highlight leading-edge research that will help define the evidence and guide decision makers through this challenging time.
References
1. US Department of Health and Human Services. Draft definition, prioritization criteria, and strategic framework for public comment. Available at: http://www.hhs.gov/recovery/programs/cer/draftdefinition.html . Accessed June 25, 2010.
2. Brandt-Zawadski M., Kerlan R.K.: Patient-centered radiology: use it or lose it!. Acad Radiol 2009; 16: pp. 521-523.
3. Saalasti-Koskinen U., Mäkelä M., Saarenmaa I., et. al.: Personal invitations for population-based breast cancer screening. Acad Radiol 2009; 16: pp. 546-550.
4. Hardin L.V., Nguyen S.A., Ravenel J.G.: Is e-mail communication effective in changing ordering patterns in the emergency department? A case study of computed tomography for pulmonary embolus. Acad Radiol 2008; 15: pp. 433-437.
5. Sasson J.P., Zand T., Lown B.A.: Communication in the diagnostic mammography suite: implications for practice and training. Acad Radiol 2008; 15: pp. 417-424.
6. Lown B.A., Sasson J.P., Hinrichs P.: Patients as partners in radiology education: an innovative approach to teaching and assessing patient-centered communication. Acad Radiol 2008; 15: pp. 425-432.
7. Neiman H.L.: Face of Radiology campaign. Acad Radiol 2009; 16: pp. 517-520.
8. Rubin D.L.: Informatics methods to enable patient-centered radiology. Acad Radiol 2009; 16: pp. 524-534.
9. Kelly A.M., Dwamena B., Cronin P., et. al.: Breast cancer: sentinel node identification and classification after neoadjuvant chemotherapy—systematic review and meta analysis. Acad Radiol 2009; 16: pp. 551-563.
10. Nandalur K.R., Dwamena B.A., Choudhri A.F., et. al.: Diagnostic performance of positron emission tomography in the detection of coronary artery disease: a meta-analysis. Acad Radiol 2009; 15: pp. 444-451.
11. DeMartini W., Lehman C., Partridge S.: Breast MRI for cancer detection and characterization: a review of evidence-based clinical applications. Acad Radiol 2008; 15: pp. 408-416.
12. El-Maraghi R.H., Kielar A.Z.: CT colonography versus optical colonoscopy for screening asymptomatic patients for colorectal cancer: a patient, intervention, comparison, outcome (PICO) analysis. Acad Radiol 2009; 16: pp. 564-571.
13. Reichman M.B., Greenberg E.D., Gold R.L., et. al.: Developing patient-centered outcome measures for evaluating vasospasm in aneurysmal subarachnoid hemorrhage. Acad Radiol 2009; 16: pp. 541-545.
14. Sanelli P.C., Gold R.L., Greenberg E.D., et. al.: Work-in-progress toward incorporating patients’ preferences in practice guidelines for imaging aneurysmal subarachnoid hemorrhage. Acad Radiol 2009; 16: pp. 535-540.
15. Kelly A., Cronin P.: Setting up, maintaining and evaluating an evidence based radiology journal club: the University of Michigan experience. Acad Radiol 2010; 17: pp. 1073-1078.
16. Bresnahan B.W.: Economic evaluation in radiology: reviewing the literature and examples from oncology. Acad Radiol 2010; 17: pp. 1090-1095.
17. Reichman M., Gold R., Greenberg E., et. al.: Validation of a new reference standard for the diagnosis of vasospasm. Acad Radiol 2010; 17: pp. 1083-1089.
18. Gold R., Reichman M., Greenberg E., et. al.: Developing a new reference standard…is validation necessary?. Acad Radiol 2010; 17: pp. 1079-1082.