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The Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes was established through a Rutgers University Academic Excellence Fund. Directed by Professor Stephen Crystal, the Center fosters collaborative research on pharmacotherapy and chronic disease management among investigators from multiple disciplines and academic units within Rutgers University including the Departments of Sociology, Economics, Statistics, Rutgers Biomedical and Health Science’s (RBHS), Ernest Mario School of Pharmacy, School of Nursing, Robert Wood Johnson Medical School, the School of Public Health, the Graduate School of Applied and Professional Psychology, School of Social Work, E.J Bloustein School and external collaborators including Columbia University’s Department of Psychiatry, multiple state Medicaid, mental health, and child welfare agencies, the National Committee for Quality Assurance (NCQA), the FDA, the Centers for Medicare and Medicaid Services, and many other federal agencies.
One line of the Center’s research focuses on understanding the complex factors and processes that shape the utilization of pharmacotherapy and providing a stronger knowledge base for quality improvement and more-effective use of medications, especially in managing individuals with chronic health conditions. Available pharmacotherapies provide increasing potential for reducing the large disabling impact of diabetes, coronary artery disease, hypertension, asthma, chronic obstructive pulmonary disease, depression and many other illnesses. Biomedical research and development are providing an increasingly powerful armament of drugs with enormous potential for improving health outcomes if effective treatments reach the appropriate clients consistently. The health care system performs remarkably poorly in achieving this goal. Appropriate and consistent use of effective treatments is often the exception rather than the rule, and our pharmacoepidemiological and pharmacoeconomic knowledge base is woefully underdeveloped.
The failure to attain effective and consistent use of pharmacotherapies involves multiple factors at the client, provider and system levels. Most information on outcomes of pharmacotherapy comes from relatively short-term, limited size clinical trials conducted in a limited number of settings prior to the approval of new drugs. Information is inadequate on the actual patterns of therapy in large-scale clinical practices as well as on the economic, clinical and social outcomes of treatments in large, socioeconomically and clinically diverse populations. While clinical trials that lead to drug approval provide evidence of efficacy (outcomes under tightly controlled conditions in highly selected, relatively homogeneous client populations), effectiveness in real-world settings with heterogeneous client populations is another matter.
Studies at the Center evaluate the impact of policy and health care system changes, such as the implementation of the Affordable Care Act on effective pharmacotherapy use and chronic care management. Public/Academic partnerships with many state and federal agencies provide a laboratory of natural experiments to test policy effectiveness and improve the quality of health services. The use of large administrative data sets focuses on patterns of use of pharmacotherapies, outcomes and cost-effectiveness of therapies. The Academic Excellence Fund award has fostered outstanding research and training, contributed importantly to health care improvement and population health, and enriched academic and service missions of the University. Center investigations have provided the foundation for sustainable external support for a coherent, multidisciplinary set of initiatives on effective use of pharmacotherapy in combination with other evidenced-based therapies for more effective chronic disease management.
Stephen Crystal, Ph.D.