Cooperative Studies Program Central Office, US Department of Veterans Affairs, Washington, District of Columbia 20420, USA.
Am J Med. 2010 Dec;123(12 Suppl 1):e24-31. doi: 10.1016/j.amjmed.2010.10.005.
Comparative effectiveness research (CER) has the ability to improve health and inform patients, clinicians, and decision makers. However, calls for more devoted efforts with regard to CER have been countered by methodological, resource, and translational challenges related to conducting these studies. The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) is a clinical research infrastructure that has contributed much evidence to support clinical practice for several decades. Although the CSP does not exclusively focus on CER, it employs strategies that lend themselves toward the planning and execution of studies that seek to compare interventions and/or strategies for treating disease. Consequently, the CSP provides a model for addressing important scientific, structural, and operational factors for clinical research, including large, national and multinational comparative effectiveness studies. Exploration of the difficulties the CSP has encountered can help to elucidate barriers that face CER. This article discusses factors and approaches for collaboratively developing and conducting definitive studies that produce outcomes aimed at influencing clinical practice, lessons that have resulted from such efforts, and ongoing challenges. Future program directions are also presented to highlight areas of emphasis and implications for CER within the VA and nationally.
比较效果研究（CER）有能力改善健康状况，并为患者、临床医生和决策者提供信息。然而，人们呼吁加大对 CER 的投入，但与开展这些研究相关的方法学、资源和转化方面的挑战却对此提出了反对。美国退伍军人事务部（VA）合作研究计划（CSP）是一个临床研究基础设施，几十年来为支持临床实践提供了大量证据。尽管 CSP 并非专门专注于 CER，但它采用的策略有助于规划和执行旨在比较干预措施和/或治疗疾病策略的研究。因此，CSP 为解决临床研究的重要科学、结构和运营因素提供了一个模型，包括大型的、全国性和多国的比较效果研究。探讨 CSP 所遇到的困难可以帮助阐明 CER 面临的障碍。本文讨论了合作制定和开展明确研究的因素和方法，这些研究旨在产生影响临床实践的结果，以及从这些努力中获得的经验教训和正在面临的挑战。还提出了未来的项目方向，以突出 VA 和全国范围内 CER 的重点领域和影响。
