The Patient-Centered Outcomes Research Institute (PCORI) on Tuesday announced it was granting $40.7 million over three years to fund patient-centered comparative effectiveness research in the first four areas of its National Priorities for Research and Research Agenda.
The awards will fund 25 approved research projects at institutions in 17 states and includes such prestigious organizations as Boston’s Dana-Farber Cancer Institute, Baltimore’s Johns Hopkins University, and Rochester, Minn.-based Mayo Clinic, among others.
“Today marks a major milestone in our work as we build a portfolio of comparative clinical effectiveness research that will provide patients and those who care for them with the information they need to make better-informed choices about the health care decisions they face,” said Joe Selby, MD, PCORI executive director, in a press release announcing the grants. “These research projects reflect PCORI’s patient-centered research agenda, emphasizing the inclusion of patients and caregivers at all stages of the research.”
The awards are a part of PCORI’s first cycle of primary research funding. Selected projects were chosen from a pool of more than 500 research applications that were submitted earlier this year.
Research under the first awards will study a broad array of health problems including bacterial and viral infections, cardiovascular disease and stroke, certain cancers, chronic kidney disease, chronic pain, depression and other serious mental illness and pediatric diabetes. Other research will delve into how to effectively care for people with multiple conditions, as well as broader operational issues including how to improve the way health systems operate and improving patient-clinician communication.
“The approved projects propose innovative ways to study a range of serious health conditions that affect tens of millions of Americans, across diverse populations and parts of the country,” said Grayson Norquist, MD, a member of the PCORI Board of Governors and chair of the proposal selection committee, in a prepared statement. “These not only are scientifically rigorous proposals that follow the highest standards for research but also were judged by our reviewers to be patient-centered, with research teams that will engage the populations who are the focus of the studies.”
While most medical organizations are supportive of comparative effectiveness research, the handful of studies over the past decade have shown to have little effect in how doctors practice, according to a study by RAND published in the October issue of Health Affairs. The research found five separate causes for this, including: financial incentives, such as fee-for-service payment, that may militate against the adoption of new clinical practices; ambiguity of study results that hamper decision making; cognitive biases in the interpretation of new information; failure of the research to address the needs of end users; and limited use of decision support by patients and clinicians.
"Turning research findings into best practices and promoting these new recommendations remains a largely unplanned, ad hoc process," said Justin Timbie, a RAND health policy researcher and lead author of the study, in an announcement of the findings. "New approaches are needed to help research findings reach both health care providers and patients and in a format conducive to decision making."
But staff at PCORI appear to understand the history of comparative effectiveness research and the need to make the findings actionable by clinicians and that means comparing patients who suffer from multiple co-morbidities.
“What we want is for the patients to represent the real world,” said Anne C. Beal, MD, PCORI’s COO in an October report published in American Medical News. “If all the studies have been done with patients who have only one condition and nothing else, as a provider and a patient, how can I be sure the results will be meaningful to me in that particular case?”
Further, while there is anticipation that comparative effectiveness studies can eventually be one tool to help slow the growth in healthcare spending, organizations such as the American Medical Association emphasize that this research should focus on clinical outcomes first and foremost.
“PCORI must ensure that [comparative effectiveness research] is designed, communicated and used in ways that recognize variation in individual patients’ needs, circumstances, preferences and responses to particular therapies, rather than encouraging one-size-fits-all solutions based on population averages,” wrote AMA’s executive vice president and CEO James L. Madara, MD, in a March letter to PCORI.