title: Advancing the science of hospice care:  Coalition of Hospices Organized to Investigate Comparative Effectiveness.
abstract: OBJECTIVE
  There is very little high-quality evidence to guide clinical practice in hospice care. In the areas of medical therapy, patient-centered and family-centered outcomes, and patient safety, there are numerous high-impact questions for which answers are needed. Although randomized controlled trials are the gold standard for research, such trials are difficult, time consuming, and expensive to conduct in a hospice population. Moreover, they cannot examine the implementation of therapies in real-world settings. Therefore, there is a need for novel, complementary approaches to research in this unique population.
  
  
  RESULTS
  This article describes the initial experience of the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE). CHOICE is a national network of hospices that use electronic health record-based data collection procedures to answer key questions relevant to clinical care and policy. By using a rich source of existing data to conduct observational studies, CHOICE is able to overcome many of the most significant challenges of randomized controlled trials in hospice. However, this approach also created unique challenges related to governance and privacy concerns.
  
  
  CONCLUSIONS
  CHOICE is a growing research network that has the potential to make a contribution to the science of palliative care in a hospice population.
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. casarett@mail.med.upenn.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
authors.forename: Joan
authors.initials: J
authors.lastname: Harrold
authors.forename: Betty
authors.initials: B
authors.lastname: Oldanie
authors.forename: MaryJo
authors.initials: M
authors.lastname: Prince-Paul
authors.forename: Joan
authors.initials: J
authors.lastname: Teno
mesh_terms: D057186:Comparative Effectiveness Research / Q000458:organization & administration*; D003219:Confidentiality; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006265:Health Care Coalitions; D017051:Hospice Care; D006738:Hospices / Q000458:organization & administration*; D006801:Humans; D010166:Palliative Care; D014481:United States