Comparative effectiveness research and health care reform in C hina

China has made significant progress in modernizing its healthcare system in the past 20 years. However, there are some issues that are difficult to solve on the current healthcare status, including the lack of medical care satisfaction in rural areas and urban areas, excessive consumption of medical resources, conflict and tension between the healthcare provider and patients, and the problems caused by the change of model of healthcare. Therefore, the State Council introduced the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform in 2009 in order to provide basic, safe, effective, convenient and affordable healthcare for all residents. Despite the goals and policies set by the government, how to implement them remains to be challenging. Like evidence-based medicine, comparative effective research （ CER ） which started in the US in 2000 ＇s can provide diagnosis and treatment information for patients, doctors, and health policy makers to make decisions on the effective ways of caring for both individual and population. It also may apply to the conditions of healthcare reform in China. And there are opportunities and challenges of conducting CER in our country. We suggest that the government should establish the national-level CER research institute, CER Leadership Committee and relevant standards, fund the CER projects, and begin CER in certain disciplines.

Which Research Is Needed to Support Clinical Decision-Making on Integrative Medicine?——Can Comparative Effectiveness Research Close the Gap?

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research （CER） promises to support decision makers by generating evidence that compares the benefits and harms of the best care options. This evidence, more generalizable than the evidence generated by traditional randomized controlled trials （RCTs）, is better suited to inform real-world care decisions. An emphasis on CER supports the development of the evidence base for clinical and policy decision-making. Whereas in most areas of complementary and integrative medicine data on comparative effectiveness is scarce, available acupuncture research already contributes to CER evidence. This paper wil introduce CER and make suggestions for future research.

What Can Comparative Effectiveness Research,Propensity Score and Registry Study Bring to Chinese Medicine?

The impact of evidence-based medicine and clinical epidemiology on clinical research has contributed to the development of Chinese medicine in modem times over the past two decades.Many concepts and methods of modem science and technology are emerging in Chinese medicine research,resulting in constant progress.Systematic reviews,randomized controlled trials and other advanced mathematic approaches and statistical analysis methods have brought reform to Chinese medicine.In this new era,Chinese medicine researchers have many opportunities and challenges.On the one hand,Chinese medicine researchers need to dedicate themselves to providing enough evidence to the world through rigorous studies,whilst on the other hand,they also need to keep up with the speed of modem medicine research.For example,recently,real world study,comparative effectiveness research,propensity score techniques and registry study have emerged.This article aims to inspire Chinese medicine researchers to explore new areas by introducing these new ideas and new techniques.

Postrandomization Confounding Challenges the Applicability of Randomized Clinical Trials in Comparative Effectiveness Research

Different from trials for regulatory approvals of new interventions aimed to test the efficacy, comparative effectiveness research （CER） is the direct comparison of existing health-care interventions （compared with active controls） to examine which treatment works best, for whom,

Delayed assessment and eager adoption of laparoscopic cholecystectomy:Implications for developing surgical technologies

Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of LC have been conducted since 1985,and there have been nearly 8500 publications to date.As LC was adopted enthusiastically into practice,the results of outcome studies generally showed that it compared favorably with the traditional,open cholecystectomy with regard to mortality,complications,and length of hospital stay.However,despite the rapid general agreement on surgical technique,efficacy,and appropriateness,there remained lingering doubts about safety,outcomes,and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard.Using LC as a case study,there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice.We highlight one recent example,natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.

Health Analytics, Economics and Medicine toward a 21st Century Health Care System

After a review of recent developments in precision medicine, population health sciences and innovative clinical trial designs, and in health economics and policy, we show how innovations in health analytics can capitalize on the advances in biomedicine and health economics towards developing a data-driven and cost-effective 21st century health care system. In particular, we propose a mutually beneficial public-private partnership that combines individual responsibility with community solidarity in building this health care system.

Research methods in complementary and alternative medicine： an integrative review

The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine （CAM）. On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important, Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.

A primer on multiscale modelling of infectious disease systems

The development of multiscale models of infectious disease systems is a scientific endeavour whose progress depends on advances on three main frontiers:(a)the conceptual framework frontier,(b)the mathematical technology or technical frontier,and(c)the scientific applications frontier.The objective of this primer is to introduce foundational concepts in multiscale modelling of infectious disease systems focused on these three main frontiers.On the conceptual framework frontier we propose a three-level hierarchical framework as a foundational idea which enables the discussion of the structure of multiscale models of infectious disease systems in a general way.On the scientific applications frontier we suggest ways in which the different structures of multiscale models can serve as infrastructure to provide new knowledge on the control,elimination and even eradication of infectious disease systems,while on the mathematical technology or technical frontier we present some challenges that modelers face in developing appropriate multiscale models of infectious disease systems.We anticipate that the foundational concepts presented in this primer will be central in articulating an integrated and more refined disease control theory based on multiscale modelling-the all-encompassing quantitative representation of an infectious disease system.