Testimony on Comparative Effectiveness Research

Katharina Janus, Columbia University Department of Health Policy & Management

On April 3, 2009, public testimony on comparative effectiveness research was given at a meeting of the National Advisory Council for Healthcare Research and Quality. The testimony represents the views of the presenter and not necessarily those of the Agency for Healthcare Research and Quality (AHRQ) or the Department of Health and Human Services (HHS).

The Council provides advice and recommendations to the Director, AHRQ, and to the Secretary, HHS, on priorities for a national health services research agenda.

Delivered Via Electronic Mail

Comment on comparative effectiveness program

Thursday, April 02, 2009

Unfortunately, I am unable to attend this Friday's meeting, but I would like to propose the following project we have been working on during the last year at Columbia University.

Making the Correct Diagnosis—A Requirement for Effective Treatment

Executive summary:

The evidence-based medicine (EBM) and comparative effectiveness movement has largely neglected the importance of the diagnostic process in light of increasingly complex decision-making situations due to multiple and chronic conditions. More attention to increasing the likelihood of making the right diagnosis is needed in order to avoid situations where the correct treatment is given for the incorrect diagnosis.

Based on recent preliminary work, we hypothesize that clinicians differ in the algorithms (personal patterns that describe what sources of information physicians consider and whom they consult in which order) they employ in their diagnostic process and that some algorithms are more error prone and less effective and efficient than others. Clinicians will be presented clinical vignettes (that will be designed and structured based on the patterns we found) in a computer-based model including symptoms, signs and findings from physical examinations and diagnostic testing and offered various decision options on several levels until they make a treatment decision. The objective is to get to the moment where a treatment decision can be made whether or not a specific diagnosis has been confirmed.

We will develop an algorithm-based typology of diagnostic strategies under uncertainty that permits assessment of the diagnostic effectiveness and efficiency and identification of opportunities for educational, technological and management intervention.

Thank you in advance for your consideration. Please let me know if you have any questions.

Yours sincerely,

Katharina Janus

Katharina Janus, PhD, MBA
Assistant Professor
Columbia University
Department of Health Policy & Management
600 West 168th Street, 6th floor
New York, NY 10032

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