1 billion for comparative effectiveness research (CER).14 The enactment of this law was preceded by a report constructed by the Institute of Medicine (IOM), which defined the tenets of CER and developed a list of 100 priority topics for the National Insitutes of Health (NIH) to consider when funding research initiatives.15 The IOM defines CER as the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve Midostaurin chemical structure the delivery

of care. Accordingly, the following six defining characteristics of CER were described. Consistent with the definition of effectiveness, CER is conducted in settings that are similar to those in which the intervention will be used in practice. An emphasis is placed on external validity, or the ability to generalize results to real-world decision making. CER measures outcomes, both benefits and harms, that are important to patients. This is familiar to clinicians because they routinely address risks

and benefits of an intervention in practice. Assessment of patient-reported outcomes is important for CER studies in which Tamoxifen in vitro patient ratings of effectiveness or adverse events may differ from clinical measures. Methods used for CER range from nonexperimental studies (observational settings) to experiments (randomized and nonrandomized controlled trials) to synthesis of existing studies (systematic reviews and meta-analysis, technology assessments, and decision analysis). CER not only informs a specific clinical decision from the patient perspective but also directs a health policy decision from the population

perspective. Clinical questions refer to the health care of individual patients, including preventive, screening, diagnostic, therapeutic, monitoring, or rehabilitative interventions. Policy questions refer to the health and health care of populations through knowledge synthesis and transfer strategies, public health programs, or initiatives involving the organization, delivery, or payment for health services. medchemexpress CER focuses on the individual rather than the average patient by analyzing results at the population and subgroup levels. Utilization of subgroup results and clinical prediction rules assists providers and patients in individualizing management decisions. Applying new knowledge in genomics, systems biology, and other biomedical sciences in subgroups of patients with demographic, ethnic, physiologic, and genetic characteristics introduces new possibilities of individualized and predictive medicine. CER compares at least two alternative interventions, each with the potential to be “best practice.” For many clinical decisions, “optimal usual care” reflecting current standards is an appropriate potential comparator, which may include the alternative of “watchful waiting. The process by which these 100 priority topics were selected and prioritized was exhaustive and iterative.