cations during the first six weeks postpartum for Black , Asian , Hispanic , rural , and low-Socioeconomic Status ( SES ) patients ?”
This brings into play a directional shift from just “ Processes of care ” to focus on Process as it applies to culturally disparate populations . For example , in 2018 , the maternal mortality rate among whites ( 14.7 per 100K pregnant population ) and Hispanics ( 11.8 per 100K ) was less than half that of Black women ( 37.1 per 100K ). Maternal mortality by stage of pregnancy can be broken into nearly equal thirds between death during pregnancy , death during delivery , and death in the postpartum . Each of these sectors has different principal causes . For example , during pregnancy , pre-eclampsia / eclampsia and cardiovascular events are primary causes of illness and death . At delivery , hemorrhage , infection and amniotic fluid emboli are the primary causes of death . But in the postpartum , suicide and drug overdose are the chief causes . Each of these has different aspects based upon the cultural and socioeconomic status of the woman . The PCORI grants posted this year and awarded in 2022 are intended to produce actionable steps to improve health .
The 2019 Congressional reauthorization of PCORI also defined another group not clearly addressed in much of medical research : those with intellectual and developmental disabilities ( IDD ). Data presented by PCORI showed estimates that 17.8 % of children and adolescents and nearly 1 % of adults have an IDD diagnosis . That means some 7 to 8 million Americans . There appear to be larger gaps in care for this population in part due to specialized needs and higher rates of behavioral health problems . PCORI ’ s hope in awarding grants is to use research to address and fill these gaps in evidence-based mental health treatments for individuals with IDD . This will include studies to evaluate effectiveness of psychotherapy and cognitive behavioral therapy in children with IDD . PCORI is looking to fund studies that can help ascertain optimal treatment options for individuals with IDD living in rural areas , and those who are Black , Hispanic or Asian , as there is a dearth of high-quality studies existing today . PCORI has a $ 40 million target for research protocols that address the question :
“ What is the comparative effectiveness of evidence-based approaches ( e . g ., specific pharmacologic and behavioral interventions ) that address mental health conditions in individuals with IDD ?”
In a different realm , COVID-19 has changed clinical practice so much that there is a very real need to understand where telemedicine has improved health outcomes and where it has merely mollified the patient and doctor without improving health . A concern at PCORI is that telehealth , while improving access for some individuals , may also exacerbate existing health disparities . This means that there now , post-COVID-19 , must be funded studies to ascertain the appropriate use of telemedicine . Intuitively we all recognize that some patients feel more comfortable being in their own homes rather than a doctor ’ s office , so may be able to have a better outcome ; and there are those for whom a telemedicine visit increases access , giving
Health Disparities : observed differences in health outcomes across groups of people that are mainly driven by economic , social or environmental disadvantage ( Healthy People 2030 )
e . g ., race / ethnicity , income , cultures , disability status , sexual orientation
Health Equity : principle underlying the goal that “ Everyone has a fair and just opportunity to be as healthy as possible .” 3
Achievement of this goal requires policy changes , financial investment , programming , and interventions for specific groups
4
PCORI Advisory Panel on Healthcare Delivery and Disparities Research , Spring Meeting , May 6 , 2021 , Washington DC ( virtual )
FEATURE
better outcomes . Certainly , it has been touted for use in rural areas , for the elderly person for whom transport is risky , pricey or absent , and for behavioral health conditions . During the pandemic , there has been an expansion of covered services , including telephonic only , with payment granted on an emergency basis . What PCORI wants to fund are the studies defining specific subsegments of the population for whom there is greater acceptance of telemedicine , and the subsegments who have improved outcomes compared to in-office visits .
PCORI is looking toward the funded research to measure those elements of telemedicine which result in positive patient health outcomes . In its Spring Meeting , PCORI staff posed questions as to how studies could be designed to include telemedicine in the management of chronic diseases in vulnerable populations . For instance , think about the use of telemedicine for a set of diabetic patients with Intellectual Disabilities . That would require a different strategy than for telemedicine in the general population of people with diabetes .
The Spring Meeting ended with discussion on the National Priorities for Health being influenced by specific themes including :
» Health Equity — Disparities and systematic inequities
» Emerging Innovations — new technologies and systems for rapid decision-making on their utility
» Learning Health Systems — Health systems that learn from and teach to individuals
» Communication , dissemination , Implementation — Right information to right person at right time
» Infrastructure and workforce — Building capacity for patient centered outcomes research
Of this group of themes for the National Priorities as defined by the CDC and CMS , Health Disparities is at the top of the list . PCORI believes that research into the causes of health disparities is not the end game . The reason for such studies is to develop ( continued on page 14 )
JUNE 2021 13