Surgery and percutaneous interventions account for nearly half of healthcare spending in the United States, with an estimated 50 million procedures performed each year. In a major challenge to common practice, the Institute of Medicine estimates that over 1/3 of health care spending involves procedures and treatments that neither extend life nor improve the quality of life. In reality, across all arenas of care, procedures are integrated into practice before their clinical value, risk, and comparative effects are determined. Widespread use occurs before surveillance systems are established to assure their safety and quality in the “real world” rather than in ideal research settings. There is a lot of evidence that the safety and effectiveness of care in the general community varies considerably, but before CERTAIN we had no real system to monitor or address it.
Assessment of “real world” comparative effectiveness and dissemination of that information back into clinical practice is critical. That is especially true in surgical and interventional fields, given the cost of these interventions and the risk of serious adverse events. Furthermore, many of the nation's priority health conditions (e.g., cancer, diabetes, cardiovascular disease, depression, arthritis, infectious disease, obesity and functional disability, pre-term birth) are treated with or commonly impacted by procedures and interventions.
CERTAIN is a unique platform for community-based, comparative effectiveness research that partners with the Surgical Care and Outcomes Assessment Program (SCOAP), a unique quality improvement program in Washington State, to bring us closer to having a learning healthcare system. A learning healthcare system recognizes that innovation offers great promise but also raises important research questions about safety, effectiveness, and value. By tracking the use of procedures in general practice, researchers can help us learn what we need to do better and drive clinical practice.
CERTAIN moves beyond “in-hospital” surgical and interventional surveillance to comparative evaluations of healthcare strategies across the episode of care (pre- and post-intervention). It incorporates all healthcare stakeholders and includes information about outpatient and long-term care, patient-reported outcomes, non-interventional comparison cohorts, and costs. Because CERTAIN strives to tell the healthcare story from all points of view, researchers are able to use that information to tell a complete and accurate picture of the actual effectiveness of treatments. Rather than limited to studying a procedure from the point of view of the hospital (e.g., administrative claims or billing data) or the clinician (e.g., medical records), CERTAIN includes the patient perspective (e.g., patient-reported outcomes). With this rich data, the CERTAIN learning healthcare system is a laboratory for researchers and a unique opportunity for collaboration.
Contact us if you are interested in collaborating with us on a current project or in using CERTAIN data for a research investigation.
The Partnership between Quality Improvement and Comparative Effectiveness Research
During the Fifth Annual SCOAP Statewide Retreat, Dr. Sean Sullivan gave a presentation on comparative effectiveness research and the unique partnership between SCOAP and CERTAIN that creates a learning health system in Washington State. For an overview of his presentation and to see the slides, click here.