Comparative Effectiveness Research
United States (US) healthcare expenditure has continued to grow over the past three decades, despite the promise that improved resource allocation, biomedical research and technology would improve both efficiency and outcomes. Current estimates from the United States Congressional Budget Office (CBO) estimate that 4 percent of the 2007 Gross Domestic Product (GDP) was allocated to Medicare and Medicaid. This amount is estimated to grow to up to 20 percent of the federal budget by 2050 if current projections remain true. Thus, healthcare expenditure is quickly becoming the most significant factor in the already strained United States federal budget. Payment for the treatment of peripheral arterial disease (PAD) represents a significant amount of healthcare resource allocation. In 2007, the United States spent 151 billion dollars in direct and indirect costs for the treatment of 12 million beneficiaries with PAD.
It is clear that these current trends are untenable within the constraints of the economic system. Vascular care is likely to become increasingly important, as the overall population ages. It will become paramount to evaluate the appropriate treatment of each patient with vascular disease within the overall context of the national healthcare system.
Comparative effectiveness research (CER) must provide the scientific basis for this process. Simply put, comparative effectiveness is the study of two or more treatment options to address a given medical condition. Within the domain of vascular disease, there is an ever-increasing array of options and modalities to address our patient’s disease processes. Many of these new modalities compete with either non-operative management or traditional operative techniques, and have not been fully evaluated with respect to efficacy and healthcare economics. The implementation of CER may be ideally suited for mechanisms such as Accountable Care Organizations. Within this construct, patients and providers use evidence-based medicine to decide on clinically and financially treatment courses, and both benefit from maximizing these factors. Within the vascular disease space, this is accomplished by choosing the safest, most efficacious and durable procedure. These factors have begun to translate into the federal regulatory process, as the Food and Drug Administration is now considering patient-centric outcomes for new device approvals.
Dr. Stoner is actively involved in CER and value-based research, which is the scientific cornerstone of creating a sustainable healthcare framework. Research includes care process and value proposition optimization for aortic surgery (figure), and a critical analysis of evolving technologies.
Cardiovascular Device Design Program
The Cardiovascular Device Design program is part of the MS program in Medical Technology Innovation. The program's focus has broadened into other medical specialties, such as:
Cardiovascular Engineering Lab
Michael Richards, right, a research assistant professor in the Department
of Surgery at the University of Rochester Medical Center and Doran Mix,
vascular surgery resident physician in the Richards lab, are developing
a novel ultrasound technology to characterize the structure of aortic
abdominal aneurysms and blockages in carotid arteries, in
collaboration with Carestream Health Inc.
The University of Rochester Medical Center Cardiovascular Engineering Lab (CVEL) involves a cross-disciplinary, multi-institutional team working towards solving cardiovascular problems using engineering principles. The cardiovascular system is governed by forces prevalent in engineering, and the team of clinicians and engineers work together on problems faced in the cardiovascular field which can be solved through the application of engineering.
The lab is currently focus on AAA (abdominal aortic aneurysmal) disease which causes an enlargement in the blood vessel of the abdomen, and can be fatal if the aneurysm ruptures. Currently the lab is conducting translation benchtop research and clinical trials, in an attempt to develop a novel ultrasound based imaging technique to provide patient specific individual risk of aortic rupture. The long term goal of the lab is to create novel diagnostic, therapeutic, and predictive devices and tools which have the ability to improve overall delivery of cardiovascular care for patients.
Under the expertise of the Clinical and Translational Science Institute (CTSI), the Surgical Health Outcomes & Research Enterprise (SHORE ) is a center designed to develop new and enhance existing research efforts through one integrated, multi-disciplinary program. This Enterprise will identify the most effective ways to organize, manage, finance, and deliver high quality care, while reducing medical errors, controlling costs, and improving patient safety.
Within the mission and vision of URMC, lie the goals of the Surgical Health Outcomes and Research Enterprise. These goals are to transform the field of Health Services Research among surgical disciplines in an effort to improve the delivery of clinical care through collaborative comparative effectiveness research efforts and health technology development. In addition, through the development of research expertise a second mission is to establish a financially successful academic program of education, training and research output using novel models of resident education currently being developed within SHORE.
The URMC Surgical Health Outcomes and Research Enterprise will achieve Medicine of the Highest Order through the integration of existing resources to create surgical outcomes research sustainability as it translates to clinical care within both the Department of Surgery and across all disciplines of the University of Rochester Medical Center. Visit the SHORE website for more information.