How the Patient-Centered Outcomes Research Institute can best influence real-world health care decision making.

The Affordable Care Act of 2010 created the Patient-Centered Outcomes Research Institute to promote and fund comparative effectiveness research and to ensure that the product of this research improves real-world health care decisions. Notwithstanding limitations imposed by Congress on the institute's ability to influence federal payers' coverage and payment policies, the organization now has considerable potential to help standardize and coordinate comparative effectiveness research in the United States. Still, many questions remain about how this important new entity will function--and a central challenge will be to produce comparative effectiveness assessments that can be readily disseminated to, and used by, a wide range of health care stakeholders, especially providers and patients. I recommend that the institute adopt a comparative effectiveness assessment format that compares interventions on the basis of their clinical risks and benefits, economic considerations, and the insights they might offer into medical care. I also offer an example of how this proposed assessment and rating approach might work in the presentation of findings that weigh cardiac bypass versus angioplasty as alternatives for the treatment of coronary disease in which multiple coronary arteries require intervention.