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Introduction to CER/PCOR
Farhood Farjah, MD MPH Assistant Professor of Surgery
University of Washington
Division of Cardiothoracic Surgery Surgical Outcomes Research Center
Disclosures
• None
Acknowledgments
• Diana S.M. Buist, PhD • Senior investigator • Group Health Research Institute
Outline
• CER • Randomized studies • Observational studies
• PCOR
Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
Institute of Medicine, 2009
CER is the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnosis, treat and monitor a clinical condition or to
improve the delivery of care. The purpose of CER is to assist consumers, clinicians,
purchasers, and policy makers to make informed decisions that will improve health care at both
the individual and population level.
Tammemägi, NEJM, 2013
GHC
KPSC
KPCO
KPHI
GHS
0 6 12 18 24 30
MC
36
Observational studies
• Generalizability • Clustering • Confounding • Causality
Confounder
Intervention Outcome
Intervention
Process or Event
Outcome
Confounder
Specialty
Staging & Treatment
Survival
Confounders
Confounders Intervention
Outcome Intervention
Adjusted for propensity
Estimate propensity of receiving an intervention
Weintraub, NEJM, 2012
Confounders
Intervention
Outcome
Confounders
Intervention
Outcome
Instrument X
X
Baiker, NEJM, 2013
Confounders
Medicaid
Outcome
Lottery X
X
Causality—Bradford Hill Criteria • Strength • Consistency • Specificity • Temporality • Biological gradient • Plausibility • Coherence • Experimental evidence • Analogy
Rothman, Am J Public Health, 2005
Patient-centered outcomes research (PCOR)
• CER with the patient’s voice as a centerpiece
• Stakeholder engagement
Selby, JAMA, 2012
Patient-centered outcome
• Health-related outcomes that are important to patients
Cykert, CHEST, 2000
Patient-reported outcome (PRO)
• An outcome that only the patient can report
Teeter, CHEST, 1998
PRO
• Concepts and domains • Instruments • Disease-specific versus generic • Validity • Reliability • Responsiveness • Cultural/language adaptation
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