title: Comparative effectiveness topics from a large, integrated delivery system.
abstract: OBJECTIVE
  To identify high-priority comparative effectiveness questions directly relevant to care delivery in a large, US integrated health care system.
  
  
  METHODS
  In 2010, a total of 792 clinical and operational leaders in Kaiser Permanente were sent an electronic survey requesting nominations of comparative effectiveness research questions; most recipients (83%) had direct clinical roles. Nominated questions were divided into 18 surveys of related topics that included 9 to 23 questions for prioritization. The next year, 648 recipients were electronically sent 1 of the 18 surveys to prioritize nominated questions. Surveys were assigned to recipients on the basis of their nominations or specialty. High-priority questions were identified by comparing the frequency a question was selected to an "expected" frequency, calculated to account for the varying number of questions and respondents across prioritization surveys. High-priority questions were those selected more frequently than expected.
  
  
  RESULTS
  More than 320 research questions were nominated from 181 individuals. Questions most frequently addressed cardiovascular and peripheral vascular disease; obesity, diabetes, endocrinology, and metabolic disorders; or service delivery and systems-level questions. Ninety-five high-priority research questions were identified, encompassing a wide range of health questions that ranged from prevention and screening to treatment and quality of life. Many were complex questions from a systems perspective regarding how to deliver the best care.
  
  
  CONCLUSIONS
  The 95 questions identified and prioritized by leaders on the front lines of health care delivery may inform the national discussion regarding comparative effectiveness research. Additionally, our experience provides insight in engaging real-world stakeholders in setting a health care research agenda.
authors.affiliation: Research Scientist for the Department of Research and Evaluation, Kaiser Permanente Southern California in Pasadena. kim.n.danforth@kp.org.
authors.forename: Kim N
authors.initials: KN
authors.lastname: Danforth
authors.affiliation: Research Associate for the Center for Health Research-Northwest, Kaiser Permanente Northwest in Portland, OR. carrie.d.patnode@kpchr.org.
authors.forename: Carrie D
authors.initials: CD
authors.lastname: Patnode
authors.affiliation: Research Associate for the Center for Health Research-Northwest, Kaiser Permanente Northwest in Portland, and Lead Clinician at Virginia Garcia Memorial Health Center in Hillsboro, OR. tkapka@vgmhc.org.
authors.forename: Tanya J
authors.initials: TJ
authors.lastname: Kapka
authors.affiliation: Assistant Investigator for the Center for Health Research-Southeast, Kaiser Permanente Georgia in Atlanta. melissa.g.butler@kp.org.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Consulting Practice Leader for the Division of Research in Oakland, CA. bernie.collins@kp.org.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Collins
authors.affiliation: Associate Executive Director for The Permanente Federation in Oakland, CA. amy.l.compton-phillips@kp.org.
authors.forename: Amy
authors.initials: A
authors.lastname: Compton-Phillips
authors.affiliation: Senior Vice President of Community Benefit, Research and Health Policy for Kaiser Foundation Health Plan and Hospitals in Oakland, CA. raymond.j.baxter@kp.org.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Baxter
authors.affiliation: Senior Vice President, Hospitals, Quality and Care Delivery Excellence for Kaiser Foundation Health Plan and Hospitals in Oakland, CA. jed.weissberg@kp.org.
authors.forename: Jed
authors.initials: J
authors.lastname: Weissberg
authors.affiliation: Director for the Kaiser Permanente Center for Effectiveness and Safety Research in Pasadena, CA. elizabeth.a.mcglynn@kp.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.affiliation: Senior Investigator for the Center for Health Research-Northwest, Kaiser Permanente Northwest in Portland, OR. evelyn.whitlock@kpchr.org.
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
mesh_terms: D057186:Comparative Effectiveness Research; D003625:Data Collection; D019033:Delivery of Health Care, Integrated; D006801:Humans; D012106:Research; D011795:Surveys and Questionnaires; D014481:United States