DESCRIPTION (provided by applicant): The United States healthcare system spends far more than any other developed county and we consistently have worse outcomes. Comparative and cost-effectiveness research (CER2) are fields of scientific inquiry that employ innovative methods to generate knowledge aimed at improving quality and efficiency by informing the everyday decisions confronting clinicians, patients, purchasers and policy makers. This is in contrast to efficacy research, such as a randomized controlled trial, where the question is typically whether the treatment can work under a controlled environment. Because CER2 is designed to inform actual patient situations, it is much more patient-centered. Many have recognized that CER2 will be important tools to inform decisions about health promotion and disease prevention in underserved high-risk populations such as racial and ethnic minorities, persons with multiple chronic conditions, the elderly and children. The United States research community has an unprecedented opportunity to improve the nation's health system and the health of the population as well as improve efficiency through CER2; and, nurse scientists, whose research provides the evidence base for nursing practice, which is the largest clinical workforce in the United States, need to be trained in CER2 methods. This training grant, CER2 Training for Nurse Scientists, provides an opportunity to train nurse scientists in this important field. The Columbia University Medical Center (CUMC), including the Columbia University School of Nursing (CUSON), is an excellent environment to train nurse scientists in CER2 methods. This application builds upon the complementary strengths of CUSON's faculty with expertise in mentoring pre-doctoral and post-doctoral students in CER2 methods; their research foci on high-risk, underserved populations as well as the robust infrastructure of CUMC in CER2 methods. The specific aims are: 1. To recruit and retain a qualified diverse cadre of pre-doctoral and post-doctoral nurse fellows to conduct CER2 comparing the everyday effectiveness of approaches to health promotion and/or disease prevention across the continuum of care in high-risk, underserved populations; 2. To implement a training curriculum for CER2 methods that includes the integration of theories and methods used in the conduct of rigorous CER2 training for nurse scientists trainees; 3. To enhance the knowledge and skills of pre-doctoral and post-doctoral nurse scientist trainees in CER2 methods to inform patient and/or policy decisions about health promotion and/or disease prevention across the continuum of care in high-risk, underserved populations; and, 4. To evaluate the CER2 Training for Nurse Scientists program structures, processes, and outcomes on an ongoing and annual basis. These aims are well-matched to the mission of the National Institute of Nursing Research, which is to promote and improve the health of individuals, families, communities, and populations; as well as help nurse scientists to be leaders in identifying high-quality, high-value, patient-centered approaches to health promotion and disease prevention across the continuum of care.

The United States healthcare system spends far more than any other developed county and we consistently have worse outcomes. Comparative and cost-effectiveness research have been proposed as methods that should generate patient centered evidence to help improve the quality of our healthcare system while improving efficiency. This grant will provide training opportunities for nurse scientists in these important methods.