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Comparative Effectiveness Research and its Importance for Clinical Research

A recent article in the New York Times highlights comparative effectiveness research and describes its importance as an emerging paradigm for clinical research.

LPHI is the Coordinating Center for Research Action for Health Network (REACHnet), a clinical data research network (CDRN) funded by the Patient Centered Outcomes Research Institute (PCORI). REACHnet was created as an infrastructure expressly for the conduct of comparative effectiveness research in real world healthcare settings. The mission is to more efficiently generate evidence to answer healthcare questions of critical importance to patients and clinicians.

Established in 2014, REACHnet includes partner health systems in Louisiana and Texas with a combined total of more than 5 million patients: University Medical Center New Orleans, Ochsner Health System, Tulane University, and Baylor Scott & White Health. Electronic health record (EHR) data from these systems are standardized to a common format and structure to enable efficient use for research. REACHnet and its partners have developed and employed innovative methods for efficiently contacting patients to participate in research. The use of aggregated EHR data from multiple health systems, engaging patients and other stakeholders throughout the research process, and embedding research within healthcare delivery systems are significant innovations in clinical research made possible through REACHnet and other CDRNs throughout the country.

REACHnet is part of several nationwide comparative effectiveness trials currently underway. One, called ADAPTABLE, is comparing 81mg and 325mg daily doses of aspirin for preventing heart attack and stroke in individuals living with heart disease. Although aspirin is a long-standing, inexpensive, and effective life-saving therapy, research has yet to definitively determine the dose that works best for preventing heart attack and stroke while minimizing potentially serious side effects, such as internal bleeding. ADAPTABLE will enroll 15,000 participants nationwide to answer this question. Over 700 patients have already enrolled at REACHnet partner health systems.

Another study is comparing benefits and risks of the three most common types of bariatric surgery in the U.S. Using health record data for patients who underwent these surgeries, the study compares patients’ weight loss after 1, 3, and 5 years. It also examines adverse outcomes like having re-operation, being hospitalized, or dying within 5 years after surgery.

Studies like these, enabled by research infrastructures like REACHnet, will help inform patients’ and providers’ decision-making when considering the various treatment options available. If you’re interested in learning more about REACHnet, please visit our website or contact Beth Nauman, Director of Health Services Research at LPHI (bnauman@lphi.org).