Comparative Effectiveness Research and Its Application to Nursing Education

Claire Su-Yeon Park, Eunok Park, Mehmet Akif Ocak

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This in-depth integrative literature review aimed to investigate comparative effectiveness research (CER) methodologies applicable to nursing research and to propose a CER design relevant to nursing education. Integration and synthesis were conducted from August 20 to December 15, 2013 and from October 20 to December 05, 2015 using electronic databases and refereed published books. The key words were “comparative effectiveness research,” “education,” “patient outcomes,” “effectiveness,” “cost-effectiveness,” and “efficiency.” All selected literatures were initially scrutinized by the principal investigator in terms of scientific rigor and then synthesized on an ongoing basis. CER methodologies in nursing research were presented to be significant in terms of enabling the nursing profession’s distinctiveness to stand out. Three CER methodologies applicable to nursing research—a Pragmatic Clinical Trial, Observational Comparative Effectiveness Research and Cost Effectiveness Research—revealed each of their distinguishable strengths and weaknesses compared to the Randomized Controlled Trial. For ethical consideration, the importance of ensuring “equipoise” was identified. Lastly, in a head to head comparison of two nursing education programs, a single blind, randomized crossover study design was proposed as a type of Pragmatic Clinical Trial utilizing cost-utility analysis. Mixed method Analysis of Covariance and Doubly Multivariate Repeated Analysis of Covariance were suggested as relevant statistical analyses. Considering that CER is still inchoate in nursing research and nurse scientists’ endeavors to address the gap are urgent, this study is compelling in that it proposed a rigorous CER design not only directly applicable to nursing education, but also to other disciplines in education.

RECEIVED 9 December 2015, REVISED 31 May 2016, ACCEPTED 23 June 2016


comparative effectiveness research, equipoise, nursing education, cost-utility analysis, propensity score analysis

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Agency for Healthcare Research and Quality (AHRQ) (2007). Methods reference guide for effectiveness and comparative effectiveness reviews (Version 1.0). Rockville, MD, U.S.A.: AHRQ.

AHRQ (2012). Developing a protocol for observational comparative effectiveness research (OCER): A user’s guide. Rockville, MD, U.S.A.: AHRQ.

AHRQ (2013). Shape the Future of Training for Patient-Centered Outcomes Research in Primary Care. A material for a forum at the University of Flordia College of Health Professions, Nursing & Pharmacy (HPNP). Rockville, MD, U.S.A.: AHRQ.

American Nurses Association (ANA) (2015). The Nursing Process. Retrieved November 26, 2015, from

Austin, P. C. (2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. doi:10.1080/00273171.2011.568786

Basu, A. (2014). Estimating Person-Centered Treatment (PeT) Effects using Instrumental Variables: An application to evaluating prostate cancer treatments. Journal of Applied Economics (Chichester, England), 29(4), 671-691. doi:10.1002/jae.2343

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., & Mitchell, P., ... , Warren, J. (2007). Quality and Safety Education for Nurses. Nursing Outlook, 55(3), 122-31. doi:

Egan, M. & Mainous, A. G. (2012). The tension between educational equivalency and equipoise in medical education research [Editorial]. Family Medicine, 44(1), 5-6.

Feudtner, C., Schreiner, M., & Lantos, J. D. (2013). Risks (and benefits) in comparative effectiveness research trials. New England Journal of Medicine, 369, 892-894. doi: 10.1056/NEJMp1309322

Muennig, P. (2002). Designing and conducting cost-effectiveness analyses in medicine and health care. San Francisco, CA, U.S.A.: Jossey-Bass.

National Evidence-based Healthcare Collaborating Agency (NECA) (2013a). A summary of methods for comparative effectiveness research (Version 1.0). Seoul, Republic of Korea: NECA.

National Evidence-based Healthcare Collaborating Agency (NECA) (2013b). Methods for the control of measured confounders in outcomes research (Version 1.0). Seoul, Republic of Korea: NECA.

Neumann, P. J. (2013). Communicating and promoting comparative-effectiveness research findings. New England Journal of Medicine, 369(3), 209-11. doi: 10.1056/NEJMp1300312

Portney, L. G., & Watkins, M. P. (2008). Foundations of clinical research: Applications to practice (3rd ed.). Upper Saddle River, NJ, U.S.A.: Prentice-Hill.

Risjord, M. (2009). Nursing knowledge: Science, practice, and philosophy (p. 72). Wiley-Blackwell.

Saag, K. G., Mohr, P. E., Esmail, L., Mudano, A. S., Wright, N., Beukelman, T., ... , & Tunis, S. R. (2012). Improving the efficiency and effectiveness of pragmatic clinical trials in older adults in the United States. Contemporary Clinical Trials, 33 (6), 1211-6. doi: 10.1016/j.cct.2012.07.002. Epub 2012 Jul 5.

Sox, H. C., & Goodman, S. N. (2012). The methods of comparative effectiveness research. Annual Review of Public Health, 33, 425-445. doi: 10.1146/annurev-publhealth-031811-124610

Torrance, G.W. (1986). Measurement of health state utilities for economic apprasial. Journal of Health Economics, 5, 1-30.

Yang, B. M. (2012). Public Health Economics. Paju, Republic of Korea: Nanam.

Visit, G. E., Bryant, D., Somerville, L., Birminghem, T., & Oxman, A. D. (2008). Outcomes of patients who participate in randomized controlled trials compared to similar patients receving similar interventions who do not participate. Cochran Database Syst Rev, 3, MR000009.

QSEN Institute (2015). The evolution of the Quality and Safety Education for Nurses (QSEN) Initiative. Retrieved November 26, 2015, from


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Journal of Learning and Teaching in Digital Age. All rights reserved, 2016. ISSN:2458-8350