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  • ACOEM Submits Comments at Institute of Medicine’s Comparative Effectiveness Research Priorities Public Meeting

    March 20, 2009 

    Institute of Medicine’s Comparative Effectiveness Research Priorities Public Meeting

    The American College of Occupational and Environmental Medicine (ACOEM) appreciates this opportunity to present at the Institute of Medicine’s Comparative Effectiveness Research Priorities Public Meeting.

    Founded in 1916, ACOEM is a national medical specialty society dedicated to promoting the health of workers through preventive medicine, clinical care, research, and education. ACOEM is a member of the American Medical Association and the Council on Medical Specialty Societies.

    ACOEM applauds the inclusion of funding in the American Recovery and Reinvestment Act for federal agencies to oversee studies on the merits of competing medical treatments.

    The College publishes the Occupational Medicine Practice Guidelines (Guidelines) for the evaluation and management of common health problems and functional recovery in workers.  The purpose of the ACOEM Guidelines is to use the highest standards of evidence- based medicine to reduce the variation in treatment for work-related injuries and illnesses. The ACOEM Guidelines were first published in 1997, with a second edition issued in 2004, and additional revisions are being made on a continuing basis.

    In our experience, when high quality scientific evidence-based approaches are not available, not known, or not used in patient care, the result is inappropriate variation in care. Variance in medical care, when compared to best practices, for similar conditions produces less than optimal outcomes and is an a priori indicator of poorer quality care. While there has been progress, as in most areas of medicine, there remain significant opportunities for improvement in occupational medical care.

    The principles of evidence-based medicine and comparative effectiveness research are closely aligned. The College is pleased to suggest the following for the Committee’s consideration for Comparative Effectiveness Research Priorities.

    • The federal government’s role in comparative effectiveness research provides the opportunity to establish scientific standards for the systematic identification of high-quality original research studies on a topic, including standards for the critical analysis and assessment of methodological quality of such studies. Today, many clinical practice guidelines are often based on the use of lower quality medical evidence.
    • Comparative effectiveness research should combine safety and clinical effectiveness with cost effectiveness. The more costly the test or intervention, the more caution should be generally exercised prior to ordering the test or treatment and the stronger the evidence of efficacy should be. When two treatment methods appear equivalent, the most cost-effective method should be identified.
    • Comparative effectiveness research should have explicit objectives, content areas, intended target audiences, and desired outcomes. Is the treatment intended to return the individual to work or to return the individual to optimal function or to eliminate pain? A case in point is opioids management in patients with chronic pain. Opioids are a potent analgesic widely viewed as helpful for managing moderate to severe acute pain and cancer pain. For example, the desired treatment outcome from the use of opioids may be much different for a Medicare patient with generalized cancer pain and a 30-year old truck driver experiencing low back pain.

    Thank you.