The ACC annual Medical Directors’ Institute (MDI) was held this week at the Park Hyatt and Heart House in Washington. The topic was comparative effectiveness research and implementation. It was a terrific policy discussion which included dynamite presentations from AHRQ Director Carolyn Clancy, the UK’s CER agency NICE, Canada’s similar entity, the US Veterans’ Administration, the CMS, the National Health Council, and many other stakeholders in addition to ACC senior leaders, governors, and staff. We strongly support CER, and also want to make sure it proceeds along the lines of a patient-centered, socially responsible, and scientifically excellent path through some difficult political minefields.

The timing for this MDI was perfect in that ACC had just published our own CER policies and principles, called “ACC 2009 Advocacy Position Statement: Principles for CER.” The position statement offers nine principles for CER, outlined in brief below:

• The ACC strongly supports CER as a way of having informed decision-making.
• CER priorities should be set by a multi-stakeholder group to ensure that the research agenda reflects the needs of the country. The research agenda should be based the burden of the disease being considered, mainly morbidity and mortality.
• The ACC recognizes that the research on comparative effectiveness is “only the first step in improving the quality, equity and efficiency of medical care,” and stresses that improving quality must be the primary aim of CER.
• CER should be distinct from entities that create coverage and benefit programs, and requires close monitoring to avoid adverse consequences on access, quality or safety.
• The ACC recognizes that CER will require substantial and long-term financial support.

The paper then goes on to outline how the ACC can participate in the CER process, including informing priorities through our clinical documents, like guidelines and appropriate use criteria, as well as our registries (NCDR) and providing standardized data elements and definitions. In addition, the ACC has the ability to disseminate CER findings to patients through our large membership. The policy statement concludes: “The ACC believes CER research, when conducted correctly, is a useful tool that assists physicians and other providers in delivering high-quality, equitable and effective health care to patients.”

Comparative effectiveness is a frequent topic on this blog (see the post from John Brush, M.D., F.A.C.C.), and clearly has the potential for good – improved quality – and, if done poorly, a potential for evil – reduced access to needed treatments. Because of its potential for evil, I strongly believe that comparative effectiveness needs to happen separately from any cost comparison. This is necessary to maintain physician and patient (consumer) trust that CER is untainted scientifically from societal/government pressure to reduce costs.

Those are my thoughts on CER ... but there have certainly been some spirited discussion by our CER experts here at MDI that disagree with me. We’ve had some great speakers, including a senior scholar at the Institute of Medicine Michael McGinnis, M.D., M.P.P., Myrl Weinberg, president of the National Health Council, panels that include representatives from the Canadian Agency for Drugs and Technology in Health and U.K.’s NICE, and Carolyn Clancy, M.D., of AHRQ representing the U.S., and a briefing from Michael Rapp, M.D., of CMS, among many others.

UPDATED 10/28: New CVN video on "Perspectives on CER" with an introduction from SVP of Science & Quality Janet Wright, M.D., F.A.C.C., and thoughts on CER from attendees of MDI.