To help ensure that funds were directed to areas of clinical need, ARRA further mandated that the Institute of Medicine (IOM) establish a list of national priorities for CER. The final IOM report, released in June 2009, identified 29 broad “research areas” within which 100 primary and 193 secondary research priority topics were defined (more than a quarter of which pertained to health care delivery systems or racial and ethnic disparities).⁵

ARRA funds have since been fully disbursed by the three parent organizations, with each having a slightly different focus.

The OS-DHHS concentrated largely on strengthening the infrastructure for CER data compilation and dissemination, and the NIH centered on specific research projects (88 of which were on the IOM’s list of 100 primary priority topics). The AHRQ engaged in a more broad-based effort to:

• Work within preexisting CER programs such as the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) network.
• Support evidence synthesis through the creation of Evidence-based Practice Centers.
• Derive new evidence through funding of Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) grants.
• Invest in disease or service specific registries.
• Expand the available workforce of CER researchers through career development awards.
• Devise and test strategies to incorporate CER findings into clinical practice.
• Promote citizen engagement and uptake of CER.³

Because the vast majority of funds were obligated in fiscal year 2010 (see www.hhs.gov/recovery/programs/#Comparative for complete details), it is not yet possible to know the relative value of the ARRA CER initiative.

Though ARRA was clearly an important mechanism to initiate organized funding of CER, the program was, by design, finite in scale. As ARRA funding winds down, however, a new phase of CER funding will ramp up in the form of the Patient-Centered Outcome Research Institute (PCORI), a novel public-private partnership that was established by the Patient Protection and Affordable Care Act of 2010.

Starting in 2013, it will be permanently funded (to the tune of $500 million a year) by a trust derived from a nominal tax on Medicare and every private health insurance company for each life they insure. A primary function of PCORI will be to establish a CER portfolio and commission related projects within the confines of a fixed budget – a task that, according to leading figures in the FCC and the IOM, will likely require that PCORI define not only the research questions but also the methodology necessary to adequately address them.^3,6