[Eye on Patients is a recurring series on improving the quality of care and patient safety within hospitals. This article is excerpted from a story by Chicago-based freelancer Geri Aston that first appeared in the January issue of Trustee magazine, an AHA and Health Forum publication.]

The $1.1 billion in new federal funding for comparative effectiveness research presents a host of opportunities but also some challenges for hospitals.

The term "medical research" typically brings to mind strictly controlled, randomized clinical trials conducted at major academic medical centers. But federal officials emphasize studies about "real patients" in "real settings" when it comes to comparative effectiveness evaluations, which examine the difference in effectiveness between drugs, devices and interventions for the same condition. That means more chances for community hospitals to get involved, several experts say.

Real World, Real Money. The Agency for Healthcare Research and Quality (AHRQ) received $300 million of the $1.1 billion in comparative effectiveness research funding. In its operating plan for the use of this money, AHRQ lays out its intention to finance different types of studies with looser criteria for patient participation than is typical in randomized clinical trials.

For example, the agency plans to spend $100 million next year on up to 10 Clinical and Health Outcomes Initiative in Comparative Effectiveness, or CHOICE, studies, which it describes as "pragmatic studies" focused on comparing the benefit of treatments in routine clinical practice on real-world populations.

Another $48 million will fund up to five registry studies, which use databases that collect clinical data on patients with a specific disease or that track outcomes associated with specific medical tests, devices or surgical procedures. AHRQ already has issued a request for applications for an organization to conduct a registry study on orthopedic drugs, devices and procedures. Data must be collected from at least five institutions performing high volumes of hip and knee replacements.

Where Hospitals Come In. Engaging in comparative effectiveness research offers several advantages for hospitals, says Peter J. Pronovost, M.D., a health policy and management professor at Johns Hopkins University in Baltimore, MD. The studies are meaningful for physicians; they help elevate the quality of care because they use the best evidence; and their prestige offers a brand benefit, he explains. "We have an awful lot of need to generate new knowledge, and hospitals could be participating in this knowledge generation," he says.

Once the research findings start coming in, hospitals will be on the frontlines of making sure they're actually put into practice, says Brian Strom, M.D., vice dean of the University of Pennsylvania's medical school in Philadelphia. "They should be the ones saying, 'We don't want to pay for this expensive drug anymore because it isn't any better' or 'we have to pay for this expensive drug now because it is better,'" he says.

The push for more comparative effectiveness research is occurring along with a societal trend to hold providers accountable for ensuring that they offer the best care. The findings will increase the pressure on hospitals to make sure that each patient gets the most effective care every time, says Arnold Milstein, M.D., a clinical professor at the University of California-Medical Center.

"There is a huge national opportunity to deploy some of the comparative effectiveness research money, not in comparing treatment options, but rather in comparing different treatment application methods, Milstein says. "That's where you get into the question of now that you've figured out the right treatment, how do you make sure it's implemented effectively, safely, patient-pleasingly and without wasting resources?"

Getting information on what treatment works best on which patients into physicians' hands will require electronic clinical decision-support tools, Milstein says. "It's never going to work as the number of treatment selection rules increases for doctors to sort of carry this around in their brains," he says. Computerized decision-support tools could be designed to prompt a physician when the results of a comparative effectiveness study are relevant to a patient, note the treatment option the findings suggest, and allow the doctor to click on a box to order that treatment, he explains.

The federal government also is interested in making sure hospitals and other providers use the new evidence. For example, AHRQ plans to spend $34.5 million on projects aimed at implementing innovative approaches to integrating comparative effectiveness research findings into clinical practice and health care decision-making.