Office of Research and Development, US Department of Veterans Affairs, Washington, District of Columbia 20420, USA.
Am J Med. 2010 Dec;123(12 Suppl 1):e3-7. doi: 10.1016/j.amjmed.2010.10.002.
A particular challenge for the healthcare provider and the patient is to choose among competing therapeutic approaches for a particular condition. Often, the relative benefits and risks of potential therapies are not uniformly available from the existing scientific information. Many have pointed to the need for more comparative effectiveness research (CER) to aide in these decisions. The US Department of Veterans Affairs (VA) has a long history of conducting CER. The success of the VA CER program has been facilitated by several important aspects of scientific infrastructure related to (1) research question refinement, (2) study design, planning and coordination, (3) evidence synthesis, and (4) implementation research. In publications that had VA coauthors in 2 major medical journals, 25% of the published studies were classified as CER. The most frequent categories of study were pharmaceutical and behavioral interventions. In the future, the CER enterprise will move toward increased input from clinicians in research topic choice and enhanced consideration of other methodologies besides the randomized controlled trial.
对于医疗服务提供者和患者来说，一个特别的挑战是在针对特定病症的多种治疗方法中做出选择。通常，潜在疗法的相对益处和风险并不能从现有科学信息中统一获得。许多人指出，需要进行更多的比较效果研究（CER）来辅助这些决策。美国退伍军人事务部（VA）在开展 CER 方面有着悠久的历史。VA CER 计划的成功得益于与（1）研究问题细化、（2）研究设计、规划和协调、（3）证据综合以及（4）实施研究相关的几个重要科学基础设施方面。在 2 大主要医学期刊中有 VA 合著者的出版物中，有 25%的已发表研究被归类为 CER。最常见的研究类别是药物和行为干预。未来，CER 企业将朝着增加临床医生在研究课题选择方面的投入以及除随机对照试验外更多考虑其他方法的方向发展。
