The US is facing great challenges in sustaining its trillion-dollar-cost healthcare system which ranked the highest in spending among all the developed countries, and with its continued annual increases in costs yet unclear improvements in care outcomes. The struggle between constraining surging healthcare cost and providing high quality of care has also become a vexing international problem for both developed and developing counties. However, as the Chinese word for “challenge” also means opportunity, this challenge ushers in new avenues for research.

A suggested solution for the challenge is to build an efficient healthcare with improved quality of care and reduced waste. To improve the efficiency of healthcare, research is needed to investigate whether healthcare resources has been over-used or under-used as both cause decreased quality of care and increased healthcare cost. More importantly, translation of the research into clinical practice imperatively requires the understanding of over-use or under-use or appropriate use of particular treatments for specific medical conditions in specific populations in terms of patient-centered outcomes (e.g. heart attack, stroke, heart failure, mortality, length of survival, acute exacerbation etc.). We need to answer questions like:

What’s the utilization rate of particular treatments in patient populations?

How many patients appropriately use a particular treatment?

Do we have evidence to determine appropriate use or use rate of a particular treatment?

Do higher treatment utilization rates of particular treatments for a specific condition always lead to higher beneficial outcomes in the population or specific populations?

Are higher costs associated with the increased treatment utilization rates justified by the higher benefit?

When multiple alternative treatments are available, the question becomes whether a particular treatment is over-used or under-used versus an alternative treatment, and this circumstance is the comparative effectiveness research (CER) of treatment effects in patient-centered outcomes.

Investigating the real-world treatment effects for CER is critical to address the above questions, which requires the use of observational data such as large health care utilization databases at the population level in real-world settings. Research using real-world population-level data is critical for several reasons: we will be able to assess the extent and patterns of utilization of a particular treatment in population, which may reveal the magnitude of potential issues or problems; the volume of CER questions means that not all can be feasibly addressed through randomized trials; observational studies can examine larger populations including subgroups often not adequately represented in trials (e.g. minorities, the elderly, rural residents); and treatment harms may be relatively uncommon and take years to appear, requiring large sample sizes.

Therefore, our research program is anchored on the research areas in Evaluating Treatment Utilization and Outcomes in Populations (ETrUOP).