Commentary: Academic health centers and comparative effectiveness research: opportunities and challenges

The focus of comparative effectiveness research (CER) is decision making by patients, physicians, and policy makers. The key elements of CER are head-to-head comparisons of active treatments, study patients who are representative of typical practice, and the search for patient characteristics that predict differences in response to tests or treatment. The four pillars of CER are research, human and scientific capital, data infrastructure, and translation (of evidence into clinical practice). These are also among the fundamental attributes of an academic health center (AHC). This congruity of structure and purpose should mean that AHCs are well positioned to gain from conducting CER and from translating CER results into practice. This commentary discusses the fit between the missions of AHCs and the purposes of CER, using the four pillars as an organizing framework. Aside from the opportunity to do research, AHCs will see the most gains from CER if they hold themselves accountable for using the best available evidence in patient care. Conversely, practice in community settings will gain from CER only if AHCs do a much better job of teaching medical students and residents to become expert in using evidence to make decisions.