Patient-Centered Enrollment in Comparative Effectiveness Trials: Mathematical Equipoise [Methods Study], Massachusetts, 2013-2018

Comparative effectiveness research compares two or more treatments to see which one works better for certain patients. This research may include randomized controlled trials, or RCTs, in which researchers assign patients to one of the treatments by chance.
A patient may enroll in an RCT when, based on current knowledge of that patient's traits, the treatments being tested have about the same chance of helping. If one treatment is known to have a better chance of helping a patient, then the patient would not enroll and would receive that treatment from the doctor.
Sometimes there isn't enough research to show if one treatment has a better chance of helping than another. In this case, researchers may use computer programs. The programs estimate how well different treatments work in patients with certain traits. For example, a person's age and pain level may affect how much a treatment helps.
These programs would be useful for patients with knee osteoarthritis. Not many RCTs have compared total knee replacement surgery with other treatments such as medicine or physical therapy.
In this study, the research team made a computer program for patients with knee osteoarthritis. It uses data from electronic health records. The program could help identify patients for whom

The treatments in the study have about the same chance of helping. These patients may wish to take part in an RCT.
A certain treatment may help more than another. These patients could choose that treatment.

The research team also made an online system based on the program for patients and doctors to use during a visit. Doctors can use the results from the system to talk with patients about treatment. If appropriate, they could talk about taking part in an RCT.