Editor’s note: Joe Selby’s post below responds to David Introcaso’s Health Affairs Blog post, also published today. For more on the concept of patient centeredness, comparative effectiveness research, and the Patient-Centered Outcomes Research Institute, see Health Affairs’ October issue, “Current Challenges In Comparative Effectiveness Research.“
The Health Affairs Blog post by David Introcaso, PhD, “PCORI’s Problem: Reasons Are Not Causes,” emphasizes the critical importance of the patient-provider relationship and communication in improving health outcomes. It also notes the challenges to changing practice through the creation and dissemination of new evidence, including the non-linear nature of the process of turning knowledge into action. But it argues that PCORI has missed the boat on these issues, specifically having failed to address them either in the $30 million in Pilot Project awards we issued earlier this year or in our current research priorities and funding announcements.
We genuinely appreciate the serious thought Dr. Introcaso has given to these matters and fully agree with him on their importance if we are to change practice and improve patient outcomes. And that’s why both our work to date and the work we continue to pursue focuses directly on these questions in a number of concrete ways – a point he seems somehow to have missed.
The significance we at PCORI place on communication between patients and those who care for them is evident throughout our work: in our foundational research roadmap; in our initial round of research support (the Pilot Projects Program); and in the scope and detail of our primary research funding announcements’ requirements.
PCORI’s Ongoing Focus On Patient-Provider Relationships
One of our first actions was to adopt our National Priorities for Research and Research Agenda to set a framework for our research funding. “Communication and Dissemination Research” is one of our five priorities, and our funding announcement for this priority calls for studies of communication between patients and clinicians, of shared decision making, of considering patients values and preferences in the communication, and of training clinicians in the practice of shared decision making.
Our emphasis on better understanding patient-provider communication as a means of improving practice and outcomes also is evident in our Pilot Projects. One of the eight specific areas of interest listed in the solicitation for our $30 million Pilot Projects program was the study of the interactions of patients with their clinicians and healthcare systems.
Among the 50 projects funded, about two dozen include some type of focus on the patient-provider relationship and how it may be leveraged to improve care. This includes projects that are specifically developing decision-support tools, as well as others that note a goal or aim related to improving communication or interaction between patients and providers. Examples range from a project studying ways to create more open and effective patient-provider communication generally to a series of studies aimed at developing targeted interventions to bring patient preferences and concerns fully into clinical decision making in the management of chronic and mental health conditions and improving care for the underserved, elderly and those with rare diseases. The full list of these initiatives can be seen here.
We clearly emphasize this approach further in the first round of our PCORI Funding Announcements (PFAs), which solicited $12 million in proposals specifically focused on communication and dissemination research. This work will generate greater insight into how we can improve the quality of care and improve outcomes by supporting communication to clinicians and patients, as well as among patients and their caregivers and providers.
An Emphasis On Quickly Affecting Practice And Outcomes
PCORI is also keenly aware that practice change does not necessarily follow the appearance of new evidence, no matter how sound. We are committed to addressing this gap and to having a prompt impact on practice and outcomes. Several specific steps reflect this commitment. Our pilot projects also called for studies of engaging patients in the translation of evidence into practice at the level of the health care system, and at least 19 of the funded projects address this directly. We agree with Dr. Introcaso that systems re-engineering will often be necessary. For this reason, improving health care systems is the second of our five national priorities for research.
Key requirements within all PCORI’s funding announcements provide further evidence of our intention to link clinical research more tightly with dissemination and implementation of study findings. We require that both patients and other relevant stakeholders, often clinicians, be fully and meaningfully integrated into all aspects of the research process. We will not fund research that does not meet this requirement, because we believe that having the potential end users of the research present and involved throughout the process will increase chances that the findings of our studies are taken up, implemented and disseminated. Because we agree “good data” alone won’t significantly change practice, we also require that applicants for PCORI funding assess the potential and the barriers to their study findings being implemented widely into practice.
PCORI’s approach to patient-centered research values collaboration between stakeholder communities and strives to build a network of activated patients and engaged providers. Through this model, we are addressing the critical patient-provider communication issues that so often govern clinical practice. Our success is dependent on the level of input we receive, and the strength of the network we can create. We look forward to continued feedback from all members of the health and health care community as we advance toward our goal of bringing the patient’s voice to comparative effectiveness research.