Department of Pediatrics and The James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Centre, Division of Rheumatology, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
Nat Rev Rheumatol. 2014 Jan;10(1):57-62. doi: 10.1038/nrrheum.2013.140. Epub 2013 Sep 24.
Comparative effectiveness research (CER) is a growing area of investigation aimed at determining the most beneficial treatments for patients in view of their clinical characteristics. CER provides personalized treatment information that cannot be obtained from traditional clinical trials. However, many analytical challenges to performing CER remain, particularly in nonexperimental settings. The main obstacles to CER include bias from variation in use of treatments, and heterogeneity in types and quality of data across registries. Increasing standardization of care and consensus among stakeholders regarding CER methodology will strengthen the validity of CER from observational data. Innovations in outcomes measurement, and the ability to repurpose electronic health record data for research will increase the capability to assess treatment effects by CER in clinical practice. Investment in infrastructure, informatics, and data management to sustain high-quality registries, along with engagement of stakeholders to maintain a co-ordinated research agenda, are essential for successful CER in rheumatology.
比较疗效研究（CER）是一个日益发展的研究领域，旨在根据患者的临床特征确定最有益于患者的治疗方法。CER 提供了无法从传统临床试验中获得的个性化治疗信息。然而，在非实验环境中，进行 CER 仍然存在许多分析挑战。CER 的主要障碍包括治疗方法使用的变化带来的偏差，以及注册中心之间数据类型和质量的异质性。增加对 CER 方法学的护理标准化和利益相关者之间的共识将增强从观察性数据中得出 CER 的有效性。结果测量的创新，以及重新利用电子健康记录数据进行研究的能力，将提高 CER 在临床实践中评估治疗效果的能力。投资于基础设施、信息学和数据管理，以维持高质量的注册中心，以及让利益相关者参与，以保持协调一致的研究议程，对于风湿病学中的 CER 成功至关重要。
