OBJECTIVES: Describe the state of CER, its use and impact on medical decision-making, and perceptions about the future for CER, application of evidence, and impact of CER METHODS: Internet and mail survey of health care stakeholders, including government, health plans, researchers, human resources specialists, employers, and trade organizations,  that are influential in or affected by CER; telephone follow-up  to maximize response. RESULTS: The 2014 survey, the fourth in a series begun in 2010, found that health care stakeholders recognize the importance of CER but continue to believe, as in previous surveys, that significant impact of CER on treatment decisions is still in the future.    PCORI is now recognized by most stakeholders as a leading organization in establishing research priorities, funding and monitoring research, and translating and disseminating the research. The 2014 survey indicates a clear need for more and better evidence. Only five percent of respondents believe the evidence base is sufficient to inform treatment decisions, and just 10 percent indicate that real-world evidence is being used to support decision-making. About 15 percent of stakeholders indicated that variability in individual patient treatment response in being widely considered in treatment decisions. CONCLUSIONS: The 2014 survey indicates continued belief among stakeholders that CER is important to them, but the most significant impacts are yet to be felt. The environment for CER is changing, and PCORI is recognized as a key organization in the spectrum of activities related to CER.  The evidence base is not sufficiently complete to inform treatment decisions, and the influence of real-world evidence and variability in patient response are not yet apparent and warrant monitoring.