Table 2.

First tier of high-priority comparative effectiveness research questions from surveys of clinical and operational leaders in Kaiser Permanente (n = 12)^a

Survey topic area	Question/Objective
Chronic diseases and chronic disease management	Clinical effectiveness of alternatives to the physician’s office visit in managing patients with hypertension and diabetes. Looking at quality metrics in these areas, and comparing performance on the basis of number of office visits per year, and the number and quality of telephone calls, vs HealthConnect messages. What is the most effective methodology, and does it vary by patient age?
	Compare the effectiveness (including resource utilization, workforce needs, net health care expenditures, and requirements for large-scale deployment) of new remote patient monitoring and management technologies (eg, telemedicine, Internet, remote sensing) and usual care in managing chronic disease.
	Would patients with chronic conditions (ie, diabetes, coronary artery disease, heart failure) receive more effective and efficient care delivery when care is delivered in a chronic care clinic when compared with traditional primary care clinic?
Geriatrics	What is the comparative effectiveness of different staffing models in the care of frail/functionally disabled seniors? Traditional primary care physician-led primary care. Geriatric care team with strong emphasis on registered nurse support. Geriatric care team with strong emphasis on nurse practitioner support.
Health systems	Compare strategies to promote shared decision making by patients considering preference sensitive interventions vs usual care on decision outcome (screening choice, treatment choice, knowledge, treatment-preference concordance, and decisional conflict) with regard to various chronic conditions, including cancers. Possible strategies to compare include benefit designs and incentives; physician recommendation and “prescription”; and use as a “medical management” technique promoted by a health plan, payer, or employer.b
	Does colocation of behavioral health specialists (ie, social worker with a master of social work, licensed clinical social worker, psychologist, psychiatrist) in an adult primary care setting lead to improved patient outcomes including depression, anxiety, physical symptoms, physical disability, disease remission/modification (diabetes, hypertension, obesity, cardiovascular disease), quality of life, decreased absenteeism, prescription substance use, mental and physical function, satisfaction with the provider, and cost. Costs of care may include utilization of Emergency Department services, outpatient services, specialty psychiatry services, and total outpatient clinic visits.b
Mental health, psychiatry, and addiction medicine	Compare the effectiveness of case management approaches to standard individual psychotherapy in psychiatric patients with intermittent but persistent affective or anxiety disorders. Case management would include more flexible visits (eg, more frequent but shorter visit frequency based on symptom acuity, group visits, telephone visits, novel visits such as Internet chats).
Obesity, diabetes, endocrinology, and metabolic disorders	Compare the effectiveness of use of team-based approach of registered nurse (or other nonphysician) linked to a specific physician and his/her panel, with time for 3 to 20 contacts, to improve a HbA1C > 9%, compared with usual care.
Oncology and hematology	Compare the effectiveness of management strategies for localized prostate cancer: active surveillance, androgen ablation, external beam radiotherapy, brachytherapy, radical retropubic prostatectomy, laparoscopic prostatectomy, robotic-assisted laparoscopic prostatectomy. Outcomes include quality of life, survival, recurrence, side effects, and cost.b
Pain management	Compare the effectiveness of treatment of chronic pain by cognitive behavioral and physical therapy treatment programs vs primary care treatment in an adult population.b
Pediatrics	Compare the effectiveness of the most common treatment modalities applied to symptoms associated with autism spectrum disorders, including physical therapy, occupational therapy, speech therapy, and applied behavior analysis-based strategies: stratified by the number of hours per week each is applied. The outcome would be measured on the basis of “effectiveness per hour” by modality, as measured by comparative pre- and postfunctional assessment by population.b
Surgery, procedures, anesthesia, and imaging	Compare the efficacy and morbidity of radical retropubic prostatectomy vs robotic prostatectomy for localized prostate cancer.

^aQuestions are listed in alphabetical order by survey topic area. Questions are listed as nominated, except for slight editing for style and combining questions on the same topic or separating out multipart questions on different topics.

^bSurvey question was a combination of separately nominated but nearly identical questions.