LAUSR

Paradoxically, the interdisciplinary essence of health services research is both its strength and weakness. Solutions to challenges in the delivery of health care are often generated through the creative application of methods and techniques from numerous disciplines. These disciplines run the gamut from biostatistics to economics to biomedical fields to management sciences to name just a few. To be effective, then, does the health services researcher need to be a polymath? I think not. Rather, the effective health services researcher needs to be a jack of all trades and master of one. From my perspective, the most effective interdisciplinary scientific teams comprise those with expertise in one of the areas required by the study but who also have a working knowledge of the other required disciplines. The skill sets are, then, blended in productive ways. With this context in mind, in this issue of Medical Care, we present a set of commentaries on the practice of comparative effectiveness research (CER). As a perspective on health services research, these commentaries have a 2-fold purpose. For one, the commentaries seek to reacquaint the expert in the topic area with the key concepts—first principles. It is not uncommon for those who have mastered a method or a technique, and having become comfortable in that knowledge through its frequent use, to “stray” from the fundamentals now and again. It is perhaps an indication of expediency, but definitely an indication of human frailty. Beyond the expert, the other audience is that comprising those who have minimal knowledge of the topic area but may be involved in its application. For these “jacks of all trades,” the commentaries are intended to provide some guidance on how to evaluate and interpret the application of the method or technique whether reading published articles or serving as part of an investigative team that is using the technique. By no stretch of imagination will these commentaries make the novice an expert in the topic area. Drs Brooks, Chapman, and Cozad are active practitioners of CER through their Center for Effectiveness Research in Orthopedics. The Center is one of several Smart State research programs that are endowed by the State of South Carolina for the purpose of advancing the knowledge base of various disciplines to improve the health of residents of South Carolina and beyond. Of note, the research program of Brooks and colleagues is centered in the real-world, health “laboratory” of the Greenville Health System, and specifically its orthopedics group. Through this centering, real-world health care delivery problems are addressed and the proposed solutions are feasible to implement in real time in the clinics. As Dr Brooks frequently reminds me, CER is defined as “the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in real-world settings with the goal being to provide information that helps clinicians and patients choose which option best fits an individual patient’s needs and preferences.” While randomized controlled trials (RCTs) provide the gold standard of evidence to inform these real-world treatment