Louisville Medicine Volume 69, Issue 1 | Page 14

AUTHOR Tom James , MD
FEATURE

PCORI — SETTING THE NATIONAL HEALTH CARE AGENDA

AUTHOR Tom James , MD

Part of the 2010 federal legislation known as Patient Protection and Affordable Care Act ( aka PPACA , ACA or Obamacare ), set funding to establish of a body to back research focused on comparative effectiveness . That body is now known as the Patient Centered Outcomes Research Institute ( PCORI ). When President Obama submitted this legislative package , the goal was for PCORI to investigate Cost Effectiveness i . e ., determining the cost for the outcome of the service . During the political process , the cost issue was removed . PCORI now looks at whether an intervention is more or less effective than other interventions aimed at the same condition . 1

Last fall , Congress passed reauthorization funding for PCORI , granting it at least another 10 years of activity . During this past decade , around $ 2.5 billion has been awarded to over a thousand research projects . Of that sum , roughly $ 1 billion was awarded to fund 254 comparative effectiveness studies in “ Healthcare Delivery and Disparities Research ” ( HDDR ).
For the first 10 years , PCORI ’ s focus was on comparison of diagnosis and treatment options , improving health care systems , and communicating the research externally . However , there ’ s been a nuanced change in direction . There will now be a greater emphasis on the impact of the social determinants of health and not just on what the medical interventions are , i . e ., moving into the space of health equity . The assumptions have been with previously funded research that medical or organizational interventions would be applied uniformly to everyone in the targeted group . Past studies on women ’ s health may have analyzed a comparison of algorithms . For example , PCORI funded a study comparing standard of care selection of women for screening mammograms to a test algorithm employing “ clinical indication , breast symptoms , breast cancer history , and age .” 2 The study found that 12 % of mammograms of women determined through the algorithm to be at higher risk accounted for 55 % of the detected malignancies . But race and social determinants of health were not considered in that study .
For this year , PCORI has $ 50 million available for proposals to answer the question :
“ What is the comparative effectiveness of multicomponent interventions to improve early detection of , and timely care for , risk factors for postpartum complications , and for compli-
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