FEATURE
220 comparative effectiveness studies. More recent funded stud-
ies have included opioid substance use disorder, multiple sclerosis
and mental health studies. Cancer was also a recent focus. PCO-
RI expects to present the results of studies on community health
workers, rural health and care transitions. To stimulate more re-
search, PCORI has developed several different Learning Networks
on asthma, transitional care, diabetes prevention, palliative care
and telehealth. The goals of these Learning Networks are for in-
dividuals and institutions with common interests to share ideas
and help solve each other’s methodology issues in their respective
research designs.
PCORI is a small agency by Washington standards, with only
a few hundred employees, and must rely on the expertise of vol-
unteers to review the proposed and completed research projects.
Volunteers also advise researchers on mid-course corrections that
would strengthen the studies. My panel of 18 will be in place for
two years with the opportunity to renew for another term. We have
one patient, six physicians, three nurses, three people with MPH
degrees, lawyers and people with expertise in behavioral health,
social work and community organizing. The panelists came from
as far as Seattle and Los Angeles, and as close as a mile from our
meeting rooms.
The presentations were diverse but did cover a common theme
of measuring access to care. A report on promoting aging in place
demonstrated the PCORI investment in comparative effectiveness
research (CER). PCORI has spent $208 million on studies related
to aging in the home. Funded research has focused on environ-
mental factors, social support, nutrition and health care delivery
impacts. These data essentially generate a large Venn diagram. The
largest-aggregate grants went to studies on dementia care, pallia-
tive care and falls prevention. The agency is looking to fill in study
gaps for transportation, housing and environmental intervention
issues. Results should be used to guide changes in health policies.
Two studies came in for review for continued funding and for
suggestions on operational improvement. These two studies ini-
tially appeared to be very different, but we found similarities that
allowed for making recommendations. One study from Stanford
School of Medicine and the Pathways to American Indian and
Alaska Native Wellness was titled “A Patient-Centered Strategy
for Improving Diabetes Prevention in Urban American Indians.”
The second study from the University of Washington was titled
“A Comparative Effectiveness Trial of an Information Technology
Enhanced Peer-Integrated Collaborative Care Intervention for US
Trauma Care Systems.” Seventy percent of Native Americans now
live in urban environments and suffer a very high prevalence of
diabetes. Community action boards have involved Native Ameri-
cans from various neighborhoods with a scientific advisory panel
to devise culturally and locally specific variations on the Native
American Diabetes Prevention Program.
ery from significant trauma. The trauma surgeons were skilled
at treating the physical impacts of combat injuries, but just did
not have the time to devote to understanding the needs and fears
of the individual patient. Researchers started with the hypothe-
sis that “injured patients who have the opportunity to engage in
a continuing helping relationship that addresses their post-trau-
matic concerns will demonstrate reduction in the number and se-
verity of concerns as well as improvements in PTSD, depression
and physical function when compared to patients who receive
usual care.” Indeed, these injured veterans who had more support
for emotional needs had fewer emergency room visits, and fewer
identified “concerns” about future care.
PCORI has an inventory of 19 studies on reproductive health,
with awarded areas addressing contraceptive care, mental health
in pregnancy, medication-assisted treatment for opioid addiction
during pregnancy, uterine fibroids and sexually transmitted in-
fections. Women’s health is full of disparities. African American
women are three to four times more likely to die from pregnancy
than white women (700 women die in US annually) and suffer
twice the severe maternal morbidity. While maternal mortality
rates have declined since 1990 in all other Western countries, our
rate increased from 16 deaths/100,000 live births to 26.4 deaths by
2015. Studies show that 60 percent of these US deaths are prevent-
able. PCORI is funding studies comparing strategies to overcome
barriers to appropriate maternal care at the hospital and health
system level and at the community and policy level. These studies
range from greater use of telehealth to employing nurse midwives
in the OB clinics along with doctors.
The day ended with a review of suicide prevention studies. Cur-
rent predictive model tools for anticipating the highest risk of
suicide are still very blunt. We looked at comparing outcomes of
psychiatric treatment of suicidal adolescents in different treatment
settings, and one on the use of a suicide hotline. Eighty percent of
people who died by suicide had a provider contact in the previ-
ous 12 months and half had seen a professional in the preceding
month. Artificial intelligence models using electronic medical re-
cord data in evaluating risk factors add greater accuracy in identi-
fying patients at risk of suicide.
Spending a day on a PCORI panel exposed me to a wide range
of studies on a variety of topics. The panel had time to engage the
researchers and provide input into the ongoing design of the stud-
ies. I left Washington feeling as though PCORI is not part of that
city’s myriad problems, but is helping to find solutions. I felt ex-
hilarated turning off the Beltway into Maryland and then the hills
of western Pennsylvania. I look forward to the next meeting this
spring.
Dr. James is the Senior Medical Director for Highmark Inc. in Pittsburgh, PA and
also serves on the Editorial Board for Louisville Medicine.
The study on trauma dealt with veterans during their recov-
JANUARY 2020
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