Most medical evidence is derived from randomized controlled trial (RCT). However, there is growing recognition that most questions relevant to everyday clinical practice are not addressed by RCTs and are unlikely to be addressed in the future. Because of the cost and time required to conduct RCTs, they are unlikely to be widely used to address the many questions that arise in routine inpatient and outpatient care. A major interest of the CHR is in exploring other means of creating evidence that is both timely and directly relevant to clinical care. In particular, electronic health record (EHR) and other sources (e.g., claims, billing, self reported) of data offer the potential to evaluate the comparative effectiveness (CE) of dianostics, interventions, and prediction models on outcomes.
Effectiveness studies based on EHR data reflect how care is actually delivered to all patients, regardless of co-morbidities or other possible risks. CE studies can be used to complement and bridge gaps in evidence that will not be addressed by RCTs. Geisinger investigators are conducting observational studies to answer questions directly relevant to the needs of patients and clinicians. Investigators at the CHR are actively engaged in both testing and validating predictive models and in CE research.