The American Recovery and Reinvestment Act (ARRA) of 2009 placed a mandate on the Institute of Medicine (IOM) to recommend national priorities for research questions to be addressed by comparative effectiveness research (CER) and supported by the ARRA stimulus funds. Pursuant to this mandate, on June 30, 2009, the IOM released a report, titled Initial National Priorities for Comparative Effective Research (Report).  As described by the IOM, the Report “establishes a working definition of CER, develops a priority list of research topics to be undertaken with ARRA funding using broad stakeholder input, and identifies the necessary requirements to support a robust and sustainable CER enterprise.” 

The IOM Report identifies 100 priority topics for CER, which it further prioritizes into “quartiles” with the first quartile being of highest priority and the fourth quartile being the lowest.  Here’s just a sampling of the priorities in the first quartile:

• Compare the effectiveness of comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities.
• Compare the effectiveness of upper endoscopy utilization and frequency for patients with gastroesophageal reflux disease on morbidity, quality of life, and diagnosis of esophageal adenocarcinoma.
• Compare the effectiveness of management strategies for localized prostate cancer (e.g., active surveillance, radical prostatectomy [conventional, robotic, and laparoscopic], and radiotherapy [conformal, brachytherapy, proton-beam, and intensity-modulated radiotherapy]) on survival, recurrence, side effects, quality of life, and costs.
• Compare the effectiveness of various strategies (e.g., clinical interventions, selected social interventions [such as improving the built environment in communities and making healthy foods more available], combined clinical and social interventions) to prevent obesity, hypertension, diabetes, and heart disease in at-risk populations such as the urban poor and American Indians.
• Compare the effectiveness of imaging technologies in diagnosing, staging, and monitoring patients with cancer including positron emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT).
• Compare the effectiveness of the various delivery models (e.g., primary care, dental offices, schools, mobile vans) in preventing dental caries in children.

To read a 12-page brief of the larger Report, review the List of Priorities, and to access the Interactive List of CER Priorities (which is a sortable spreadsheet of the 100 priorities), go to the IOM website and click on Recent Reports.  The full Report is available for purchase or can be read on-line free here (scroll down to list of chapters).