The Institute of Medicine's Roundtable on Value & Science-Driven Health Care provides a trusted venue for sustained discussion and collaboration between national experts and health system stakeholders on issues important to improving the generation and application of evidence for healthcare decisions. The Roundtable has set the goal that by 2020, 90 percent of clinical decisions will reflect and be supported by accurate, timely, and up-to-date evidence. Anchoring their work toward this goal is a focus on three dimensions of the challenge:

1. Accelerating progress toward the long-term vision of a learning health system, in which evidence is both generated and applied as a natural product of the care process.
2. Expanding the capacity to meet the acute, near-term need for evidence of comparative effectiveness to support medical care that is most effective and produces greatest value.
3. Improving public understanding of the nature of evidence, the dynamic character of evidence development, and the importance of insisting on medical care that reflects the best evidence.

As illustrated by previous workshops and publications in the Roundtable's Learning Health System series, the nation's capacity to develop information on the comparative effectiveness of clinical interventions and care processes falls far short of the need. Evidence development often fails to meet the needs of healthcare decision makers—lacking applicability to the broad patient populations encountered in clinical practice or consideration of individual patient variation and preference. Capacity to capture and analyze clinical data relevant to point-of-care decisions is growing but remains fragmented and inefficient, often due to proprietary or privacy concerns. And systems for synthesizing, translating, and applying evidence to clinical practice remain limited.

To explore and assess the infrastructure needed (e.g., skills, workforce, methods, coordination, information networks) to expand the nation's capacity to develop and apply comparative effectiveness information, the Roundtable convened the workshop, Learning What Works: Infrastructure Required for Comparative Effectiveness Research. Emerging from discussion at the 2-day workshop was the need for coordinated and tailored infrastructure development efforts that engage key healthcare system stakeholders—patients, providers, policy leaders, information technology experts, health services researchers, health economists, and educators, among others. The discussion highlighted key gaps in current and past work, including the fragmentation and redundancy of clinical effectiveness activities; the need to take better advantage of opportunities provided by emerging health information technologies and of established local and international capacities for evidence development, synthesis, and translation; the need to develop study designs and methods that can keep pace with the development of treatments and diagnostics and support dynamic, real-time approaches to learning; and a growing appreciation for comparative effectiveness research as a discipline, with unique workforce training and skills development needs. Also noted was the counter-productivity of the current balkanization of clinical effectiveness research investments and opportunities provided by public–private collaboration. This publication summarizes the presentations and key discussion points and is rich with insights that are important to inform needed infrastructure development.

We would like to acknowledge those individuals and organizations that donated valuable time toward the development of this workshop summary, including all present at the workshop and the workshop presenters, who not only offered valuable comments but also further developed their presentations into the manuscripts contained within this summary. We would also like to thank those who provided their counsel by serving on the planning committee for this workshop, including Stuart Altman, Ph.D. (Brandeis University); Kathy Buto, M.P.A. (Johnson & Johnson); Carolyn Clancy, M.D. (Agency for Healthcare Research and Quality); David Helms, Ph.D. (AcademyHealth); Mark McClellan, M.D., Ph.D. (Brookings Institution); Peter Orszag, Ph.D. (at the time of the workshop, Congressional Budget Office; currently, Office of Management and Budget); and John Rowe, M.D. (Chair) (Mailman School of Public Health, Columbia University).¹ Roundtable staff, including Katharine Bothner, Lori Burns, Alex Goolsby, Kiran Gupta, Katie Jakubs, LeighAnne Olsen, Daniel O'Neill, Kate Sharaf, Ruth Strommen, and Catherine Zweig, were instrumental in coordinating the 2-day workshop in July 2008 and translating the workshop proceedings and discussion into this workshop summary. We would also like to thank Greta Gorman, Michele de la Menardiere, Abbey Meltzer, Robert Pool, Bronwyn Schrecker, Vilija Teel, Jackie Turner, and Jordan Wyndelts for helping to coordinate the various aspects of review, production, and publication.

The need to improve the effectiveness and value of health care is all the more pressing as economic disparities increase within the United States and globally. The development of methods to reduce costly system inefficiencies and waste and improve outcomes for each individual patient is integral to the sustainability of our healthcare system, and the implementation of infrastructure to support comparative clinical effectiveness research will provide a solid foundation.

• Denis A. Cortese, M.D.
  Chair, Roundtable on Value & Science-Driven Health Care
• John W. Rowe, M.D.
  Member, Roundtable on Value & Science-Driven Health Care, and Chair, Workshop Planning Committee
• J. Michael McGinnis, M.D., M.P.P.
  Executive Director, Roundtable on Value & Science-Driven Health Care

Footnotes

1

Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.