Clyde W. Yancy, MD, MSc, FACC, FAHA, MACP
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Clyde W. Yancy, MD, MSc, FACC, FAHA, MACP Magerstadt Professor of Medicine Adjunct, Department of Medical Social Sciences Chief of Cardiology Northwestern University, Feinberg School of Medicine & Associate Medical Director Bluhm Cardiovascular Institute Chicago, IL [email protected]

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Update on pcori a new era in research

Clyde W. Yancy, MD, MSc, FACC, FAHA, MACP

Magerstadt Professor of Medicine

Adjunct, Department of Medical Social Sciences

Chief of Cardiology

Northwestern University, Feinberg School of Medicine

&

Associate Medical Director

Bluhm Cardiovascular Institute

Chicago, IL

[email protected]

“Update on PCORI: a new era in Research”


Disclosures

Consultant/speaker/honoraria: none

Editorial Boards: American Heart Journal, American Journal of Cardiology (associate editor); Circulation; Circulation-Heart Failure; Circulation- Quality Outcomes; Congestive Heart Failure

Guideline writing committees: Chair, ACC/AHA, chronic HF; member, hypertrophic cardiomyopathy; member, ACC/AHA Guideline Taskforce, chair, methodology subcommittee

Federal appointments: FDA: Chair, Cardiovascular Device Panel; ad hoc consultant; NIH CICS study section; advisory committee to the Director; AHRQ- adhoc study section chair; NHLBI- consultant; PCORI- methodology committee member

Volunteer Appointments: American Heart Association- President, American Heart Association, 2009-2010; American College of Cardiology, Founder- CREDO

DISCLOSURES


Update on pcori a new era in research

PCORI

What is PCORI?

What is different about PCORI?

How will PCORI accomplish its work?

What has PCORI done?


Update on pcori a new era in research

PCORI Mission Statement

The PCORI

helps people make informed health care decisions – and improves health care delivery and outcomes – by producing and promoting high integrity, evidence-based information – that comes from research guided by patients, caregivers and the broader health care community.

PCORI is an independent, non-profit organization authorized by Congress committed to continuously seeking input from patients and a broad range of stakeholders to guide its work.


Update on pcori a new era in research

Taking Patient-Centeredness Seriously

Patient-Driven

Research

Patient Engagement

Dissemination

Providing patients and providers with information

for better decisions

Understanding the choices patients face

Aligning research questions

and methods with

patient needs


Update on pcori a new era in research

PCOR Definition

Helps people and their caregivers communicate and make informed health care decisions, allowing their voices to be heard in assessing the value of health care options. This research answers patient-centered questions such as:

Defining Patient-Centered Outcomes Research (PCOR)

Decisions

Options

Outcomes

Expectations

  • “Given my personal characteristics, conditions and preferences, what should I expect will happen to me?”

  • “What are my options and what are the potential benefits and harms of those options?”

  • “What can I do to improve the outcomes that are most important to me?”

  • “How can clinicians and the care delivery systems help me make the best decisions about my health and healthcare?”

6


Update on pcori a new era in research

PCOR Definition

  • In order to answer these patient-focused questions, PCOR:

    • Assesses the benefits and harms of preventive, diagnostic, therapeutic, palliative, or health delivery system interventions to inform decision making, highlighting comparisons and outcomes that matter to people;

    • Is inclusive of an individual's preferences, autonomy and needs, focusing on outcomes that people notice and care about such as survival, function, symptoms, and health-related quality of life;

    • Incorporates a wide variety of settings and diversity of participants to address individual differences and barriers to implementation and dissemination; and

    • Investigates (or may investigate) optimizing outcomes while addressing burden to individuals, resource availability, and other stakeholder perspectives.


Update on pcori a new era in research

  • .

National Priorities for Research and Research Agenda

  • .

  • .

  • .

8


Update on pcori a new era in research

Impact on Health of Individuals and Populations

Improvability through Research

Inclusiveness of Different Populations

Patient-Centeredness

Impact on Health Care System Performance

Potential to Influence Decision-Making

Rigorous Research Methods

Efficient Use of Research Resources

Addresses Current Gaps in Knowledge/Variation in Care

Criteria for Research Outlined by Law

8


Update on pcori a new era in research

PCORI

What is PCORI?

What is different about PCORI?

How will PCORI accomplish its work?

What has PCORI done?


Update on pcori a new era in research

“This is going to be research donedifferently!”

PCORI Board Member Harlan Krumholz, MD

National Patient and Stakeholder Dialogue 

National Press Club, Washington, DC

February 27,2012


Update on pcori a new era in research

What Makes PCORI Funding Different?

Special features include:

  • Patient & Stakeholder Engagement Plan

  • Dissemination and ImplementationAssessment

  • Reproducible and Transparent Research Plan

  • PCORI Criteria Outlined by Statute

  • Complies with Methodology Standards

  • User-friendly announcements to encourage broader range of applicants

12

Source: PCORI PFA Application Guidelines http://www.pcori.org/assets/PFAguidelines.pdf


Update on pcori a new era in research

Stakeholder Engagement in PCORI-funded Research

  • Patients

  • Nonprofessional Caregivers

  • Clinicians (e.g. Physicians, Nurses, Pharmacists, Counselors, and other providers of care and support services)

  • Patient-Advocacy Groups

  • Community Groups

  • Researchers

  • Health-Related Associations

  • Policy Makers

  • Institutions, Including Organizational Providers, Purchasers, Payers, and Industry

13

Key stakeholders are engaged early and throughout the research process.

PCORI will score applications on how meaningfully patients and stakeholders are engaged.

Key stakeholders include those for whom the results of the research will be relevant:


Update on pcori a new era in research

What roles should patients and stakeholders play in research teams?

14

The engagement of patients and stakeholders should include:

Participation in formulation of research questions;

Defining essential characteristics of study participants, comparators, and outcomes;

Monitoring of study conduct and progress; and

Dissemination of research results.

Source: PCORI PFA Application Guidelines (Sec. 3.1.3.4) http://www.pcori.org/assets/PFAguidelines.pdf


Update on pcori a new era in research

(placeholder slide)

Patient and Stakeholder Engagement 2012

Building communities of patients and stakeholders – using website, social media, face-to-face meetings

Strengthening ties with advocacy associations, professional clinician organizations, purchaser organizations, research community

Refining the PCORI Research Agenda

  • Convening multi-stakeholder workshops focused on each of the National Priorities

  • Forming multi-stakeholder Advisory panels

  • Using social media, surveys to obtain broad input


Update on pcori a new era in research

PCORI

What is PCORI?

What is different about PCORI?

How will PCORI accomplish its work?

What has PCORI done?


Update on pcori a new era in research

The FirstMethodology Committee Report


Update on pcori a new era in research

Methodology Report


Update on pcori a new era in research

NEJM Article and Ads

Digital Ads released in Annals of Internal Medicine; Science Translational Medicine; JAMA; NEJM; Nature; and Health Affairs


Update on pcori a new era in research

Selected Milestones in Health Care Interventions and Delivery Strategies and in Research Methods.

Gabriel SE, Normand ST. N Engl J Med 2012;367:787-790.


Update on pcori a new era in research

Methodology Report Development

  • Working groups identified and prioritized major research methods questions to be addressed

Methods Selection

  • Researchers contracted to address selected topics

  • Contractors developed research materials (e.g., reports, summary templates for proposed standard)

  • MC solicited for external feedback on the translation table (RFI)

  • Workshops held to discuss contractor findings, with invited experts in attendance

Information Gathering

Committee Expertise

  • MC conducted in-depth internal review of materials developed by contractors, and support staff

  • MC independently submitted preliminary votes on proposed standards

  • MC deliberated to reach consensus on recommendations to be endorsed in the report

Internal Review

  • Refined recommendations and report content per committee evaluations and discussions

Report Generation

22


Update on pcori a new era in research

Methodology Report – Information Gathering

17 reports* addressing 15 topics, from MC-led contracted research, informed 1st Methodology Report

Topics

Design, Conduct, and Evaluation of Adaptive Randomized Clinical Trials

Conduct of Registry Studies

Design of Patient-Reported Outcomes Measures (PROMS)

Use of Collaborative or Distributed Data Networks

Prevention and Handling of Missing Data

Design, Conduct and Evaluation of Diagnostic Testing

Causal Inference Methods in Analyses of Data from Observational and Experimental Studies

Addressing Heterogeneity of Treatment Effects: Observational and Experimental PCOR

*Reports are available on PCORI’s website (www.pcori.org)


Update on pcori a new era in research

Methodology Report – Information Gathering

Contracted Research Reports (Cont’d)

Topics

Involving Patients in Topic Generation

Value-of-Information in Research Prioritization

Peer Review as a Method for Research Prioritization

Examination of Research Gaps in Systematic Reviews for Research Prioritization

Integrating Patients' Voices in Study Design Elements with a Focus on Hard- to-Reach Populations

Eliciting Patient Perspective

PCORI Expert Interviews

*Reports are available on PCORI’s website (www.pcori.org)


Update on pcori a new era in research

Methods for Involving Patients in Topic Generation for Patient-Centered Comparative Effectiveness Research –An International Perspective

Petra Nass, Susan Levine, Clyde Yancy


Project framework

Project Framework

  • Discuss the levels of engagement

  • Summarize qualitative research strategies and methods

    • Provide specific examples

  • Discuss facilitators of public engagement

  • Describe three types of scientific research data as part of the engagement process

  • Propose a process of engagement


Levels of engagement

Levels of Engagement


Public engagement as research

Public Engagement as Research

  • Is the objective study of the individual experience

  • Uses mostly qualitative research strategies and methods


Scientific strategies the framework of engagement

Scientific Strategies the Framework of Engagement

  • Phenomenology

    • the study of experiences

  • Ethnography

    • the study of cultural phenomena

  • Grounded theory

    • the study of theory through analysis of data

  • Action research

    • the study of focused problem solving

  • Survey


Methods and processes

Methods and Processes

  • Interviews (one-on-one or group interviews, photovoice)

  • Observation

  • Documents

  • Questionnaires

  • Public-physician partnerships

Consultation

Collaboration


Views opinions experience as research data

Views, Opinions, Experience as Research Data

  • Generates mostly textual data

  • Can be categorized into themes

  • And can be translated into research areas and topics


Case 1

Case 1

  • In-depth one-on-one interviews and focus group interviews

  • 40 patients with ulcerative colitis

  • Patients identified 9 research areas

  • Only during in-depth interview patients asked about prenatal genetic testing for a possible termination of pregnancy if the fetus was affected


Case 2

Case 2

  • Public-ClinicianPartnership to developresearchtopics for urinary incontinence (James Lind Alliance)

  • Lay members and cliniciansconsultwiththeirpeers to include diverse views

  • Systematicreviews are used to generate additional topics and to avoid duplication of research

  • Nominal Group Technique to reach a consensus and prioritizetopics

    • E.g., creating a“Top 10” list of research questions


Case 3

Case 3

  • Advisory patient/stakeholder panel to identify research topics and research priorities related to urinary incontinence in women

    • What can researchers study to make your life better?

    • What should we measure to see if your life is better?

      • E.g., Patients considered quality of life the most important outcome measures.


Update on pcori a new era in research

PCORI

What is PCORI?

What is different about PCORI?

How will PCORI accomplish its work?

What has PCORI done?


Pcori awards the first experience cycle 1

PCORI AwardsThe first experience – cycle 1


Update on pcori a new era in research

4

Slate includes all applications scoring 30 or better.

Addressing disparities

(6% of PFA total)

9

Assessing options

(4% of PFA total)

6

Communication & dissemination

(7% of PFA total)

6

Improving healthcare systems

(6% of PFA total)

25

Total

(5% of total)

% of total means of those applications deemed responsive


Update on pcori a new era in research

Conditions

Comm. & Dissem.

Addressing Disparities

Assessing Options

Improving Systems

“Other” typically indicates a non-condition response to the question. Responses include: insurance coverage, primary care, surgical decision making, clinical management, comprehensive health systems., etc.


Update on pcori a new era in research

Populations Overall

Other Population includes women, disabled persons, and veterans.


Update on pcori a new era in research

Locations


Update on pcori a new era in research

Project Titles: Assessing Options

A Comparison of Non-Surgical Treatment Methods for Patients with Lumbar Spinal Stenosis.

Cognitive AED Outcomes in Pediatric Localization Related Epilepsy (COPE)

Comparative effectiveness of adolescent lipid screening and treatment strategies

Comparative Effectiveness of Intravenous v. Oral Antibiotic Therapy for Serious Bacterial Infections

Comparative effectiveness of rehabilitation services for survivors of an acute ischemic stroke

Evaluation of a Patient-Centered Risk Stratification Method for Improving Primary Care for Back Pain

Improving Psychological Distress Among Critical Illness Survivors and Their Informal Caregivers

Selection of Peritoneal Dialysis or Hemodialysis for Kidney Failure: Gaining Meaningful Information for Patients and Caregivers

Shared Decision Making in the Emergency Department: The Chest Pain Choice Trial


Update on pcori a new era in research

Project Titles: Improving Healthcare Systems

Creating a Clinic-Community Liaison Role in Primary Care: Engaging Patients and Community in Health Care Innovation

Improving Palliative and End-of-Life Care in Nursing Homes

Innovative Methods for Parents And Clinics to Create Tools (IMPACCT) for Kids' Care

Optimizing Behavioral Health Homes by Focusing on Outcomes that Matter Most for Adults with Serious Mental Illness

Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions

The Family VOICE Study (Value Of Information, Community Support, and Experience): a randomized trial of family navigator services versus usual care for young children treated with antipsychotic medication


Update on pcori a new era in research

Project Titles: Communications & Dissemination

Decision Support for Parents Receiving Genetic Information about Child’s Rare Disease

Extension Connection: Advancing Dementia Care for Rural and Hispanic Populations

Patient-Identified Personal Strengths (PIPS) vs. Deficit-Focused Models of Care

Presenting Patient-Reported Outcomes Data to Improve Patient and Clinician Understanding and Use

Relapsed childhood neuroblastoma as a model for parental end-of-life decision-making

Shared Medical Decision Making in Pediatric Diabetes


Update on pcori a new era in research

Project Titles: Addressing Disparities

Cultural tailoring of educational materials to minimize disparities in HPV vaccination

Long-term outcomes of community engagement to address depression outcomes disparities

Reducing Disparities with Literacy-Adapted Psychosocial Treatments for Chronic Pain: A Comparative Trial

Reducing Health Disparities in Appalachians with Multiple Cardiovascular Disease Risk Factors


Update on pcori a new era in research

  • Examples of Patient Centeredness in Funded Applications


Update on pcori a new era in research

The Chest Pain CHOICE Trial

  • Assessment of Prevention, Diagnosis and Treatment Options

  • “We first developed a Web-based tool to reliably determine the future risk of a heart attack. Then, incorporating feedback from patients, doctors, and researchers, developed a patient education tool—Chest Pain Choice—to help patients better understand the tests that are being performed to determine the cause of their chest pain, what these tests might show, their individualized 45-day risk of a heart attack, and the available management options.”

  • $2.03 million


Update on pcori a new era in research

Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology

  • Assessment of Prevention, Diagnosis and Treatment Options

  • “Patient-led, health educator–moderated training sessions for nurses will promote improved communication about VTE with patients. Informational materials developed with partnering patient stakeholders, including self-monitoring tools, will be provided to all hospitalized patients as a part of the admission package, empowering patients to take an active role in VTE prevention”.

  • $1.5 million


Update on pcori a new era in research

Ovarian Cancer Patient-Centered Decision Aid

  • Assessment of Prevention, Diagnosis and Treatment Options

  • “The objective of this study is to develop and test a new decision aid—named Patient Centered Outcome Aid (PCOA)—that will allow patients to assimilate information and identify trade-offs about the impact of IP/IV therapy versus IV-only therapy on their QOL and survival, based on their own preferences and personal clinical characteristics, described in terms that are meaningful to them”.

  • $1.9 million


Update on pcori a new era in research

The Family VOICE Study: A Randomized Trial of Family Navigator Services Versus Usual Care for Young Children Treated with Antipsychotic Medication

  • Improving Healthcare Systems

  • “In this study, we are partnering with parents/family advocates, child-serving agencies, and health providers to develop a Family Navigator Service to link with this medication program. Family Navigators are individuals who have cared for their own child with mental illness. The navigators will support parents, provide information on psychosocial treatment options, and address barriers to using services”.

  • $1.4 million


Update on pcori a new era in research

PATient Navigator to rEduce Readmissions (PArTNER)

  • Improving Health Care Systems

  • “We propose to engage stakeholder groups at an MSI,(minority serving institution) including patients/caregivers, in an iterative process to develop a CHW-based Patient Navigator (CHW-Navigator- community health worker) toolkit tailored to their needs to augment the benefits of a QI program to reduce readmission. We will compare the effectiveness of an integrated CHW-Navigator on the patient experience, 30-day readmissions rates, and other outcomes”.$2.0 million


Update on pcori a new era in research

Reverse Innovation and Community Engagement to Improve Quality of Care and Patient Outcomes

  • Communication and Dissemination Research

  • “We propose to adapt a World Health Organization community engagement approach to support Hospital Community Health Partnership (J-CHiP), an initiative targeting high-risk adults with chronic conditions who reside in surrounding ZIP codes. The overall goals are to improve the health of residents by enhancing communication and “co-developing” a community engagement partnership between hospitals and clinics, CBOs, and community”.

  • $2.03 million


Update on pcori a new era in research

Reducing Health Disparities in Appalachians with Multiple Cardiovascular Disease Risk Factors

  • Addressing Healthcare Disparities

  • “We will compare (a) the standard of care alone and referral to a primary care provider for management of CVD risk factors with (b) standard of care supplemented by patient-centered, culturally appropriate, self-care CVD risk reduction intervention (HeartHealth) designed to improve multiple CVD risk factors while overcoming barriers to success”.

  • $2.09 million


Update on pcori a new era in research

PCORI

What is PCORI?

What is different about PCORI?

How will PCORI accomplish its work?

What has PCORI done?


Update on pcori a new era in research

PCORI METHODOLOGY COMMITTEE

Al Berg

Brian Mittman

Ethan Basch

David Flum

Sherine Gabriel

Robin Newhouse

Jean Slutsky

Mary Tinetti

Clyde Yancy

Sharon Lise-Normand

Naomi Aronson

Michael Lauer

Steven Goodman

Mark Helfand

John Ioannidis

Sebastian Schneeweiss

David Meltzer


Thank you

Thank You!


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