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PCORI and Other Funding Sources. K Scholars Program * April 2013 Michael Steinman, MD Associate Professor of Medicine, Division of Geriatrics Director of Comparative Effectiveness Research, CTSI. Disclosure. No conflicts of interest. Outline. What is PCORI?

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Pcori and other funding sources

PCORI and Other Funding Sources

K Scholars Program * April 2013

Michael Steinman, MD

Associate Professor of Medicine, Division of Geriatrics

Director of Comparative Effectiveness Research, CTSI


Disclosure
Disclosure

  • No conflicts of interest


Outline
Outline

  • What is PCORI?

    • And what is its relation to CER?

  • Funding opportunities through PCORI

  • Other funding opportunities in CER and PCOR


Pcori
PCORI

  • 2010 health reform created Patient Centered Outcomes Research Institute

    • CER politically unpalatable (“lead to rationing”)

    • So…focus on PCOR

    • Quasi-governmental organization funded by tax on insurers

      • Protected from annual congressional appropriations

      • Cannot consider cost in coverage decisions; cannot use QALYs; will not fund cost-effectiveness analyses

      • Otherwise fairly open mandate to create something new


Pcori1
PCORI

  • Different approach to research

    • PCOR

    • Stakeholder engagement

    • “Community based participatory research for health care systems”


Patient centered outcomes
Patient-Centered Outcomes

  • “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 they work in help me make the best decisions about my health and healthcare?”


Patient centered outcomes1
Patient-Centered Outcomes

  • Prognosis; comparative options for diagnosis and treatment; improved communication and decision-making

  • Outcomes that directly impact patient’s lives and well-being

    • Functional status; ability to concentrate; care for loved ones; pain; NOT biomarkers

    • Effect size should be meaningful

    • Evaluate heterogeneity of treatment effects

    • Real-world settings


Stakeholder engagement
Stakeholder Engagement

  • Central to PCORI’s mission

    • Stakeholders should be involved in ALL aspects of research

      • Developing research plan, measures, etc.

      • Patients, providers, policy-makers, etc.

    • Stakeholders sit on review panels


Guidance
Guidance

  • PCORI Methodology Report and Methodology Standards

    • Explicit guidance on preferred methods

      http://www.pcori.org/research-we-support/methodology/


Pcori funding opportunities
PCORI Funding Opportunities

  • PFAs – investigator initiated projects

  • Targeted announcements

  • Special programs


Pcori funding announcements pfas
PCORI Funding Announcements (PFAs)

  • PCORI Funding Announcements

    • 3 cycles per year

    • 3 years, up to $500K per year

    • ~$350 million in 2013

  • Five priority areas


First round of pfas
First Round of PFAs

  • 25 proposals funded (out of ~500)

    • $41 million over 3 years


First round of pfas1
First Round of PFAs

  • Prevention, Diagnosis, Treatment

    • Cognitive outcomes of antiepileptic drugs in pediatric epilepsy

    • Helping patients choose peritoneal dialysis vs. hemodialysis

  • Healthcare Systems

    • Hospital discharge planning – impact on medication problems, functional status, re-hospitalization


First round of pfas2
First Round of PFAs

  • Prevention, Diagnosis, Treatment

    • Cognitive outcomes of antiepileptic drugs in pediatric epilepsy

    • Helping patients choose peritoneal dialysis vs. hemodialysis

  • Healthcare Systems

    • Hospital discharge planning – impact on medication problems, functional status, re-hospitalization

Patient-centered outcomes

(Outcomes, heterogeneous effects, real-world)


Targeted announcements
Targeted Announcements

  • Five target areas

    • Treatment options for uterine fibroids.

    • Treatment options for severe asthma in African-Americans and Hispanics/Latinos.

    • Preventing injuries from falls in the elderly.

    • Treatment options for back pain.

    • Obesity treatment options in diverse populations.

  • Actual funding announcements will be posted by July 2013 (in theory)


Special opportunities
Special Opportunities

  • PCORI Challenge

    • Developing a patient/research “matching” system

    • $50,000

  • Others coming down the pike…


Not only pcori
Not only PCORI

  • Alternative funding sources

    • AHRQ

    • NIH

    • VA

    • Foundations

  • Can do things that PCORI cannot

    • Career development

    • Cost effectiveness

    • Non-patient centered outcomes


Pcori and other funding sources
AHRQ

  • Beginning series of FOAs in PCOR

    • Mentored Career Development in PCOR

      • Junior Investigator: K01; K08

      • UCSF K12 PARTNERS Program

      • Mid-career or Senior Investigator: K18

    • Infrastructure Development Program in PCOR

      • R24

        http://www.ahrq.gov/funding/research/announcements/index.html

        http://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-003.html

        http://accelerate.ucsf.edu/training/partners


Pcori and other funding sources
AHRQ

  • CER is one of seven AHRQ “portfolios”

  • Intramural and contract-based work in CER

    • Effective Health Care Program

    • Evidence-Based Practice Centers

      • Synthesize evidence for conditions or technologies

    • CERTs

      • Research and education drugs and devices

    • DeCiDE Network

      • Practical studies on outcomes, CER, safety, appropriateness

        http://www.ahrq.gov/cpi/portfolios/comparative-effectiveness/index.html


Pcori and other funding sources
NIH

  • Lots of funding in 2009-10 under ARRA

  • Now selected RFAs:

    • Secondary Analyses of Comparative Effectiveness, Health Outcomes and Costs in Persons with Multiple Chronic Conditions (R21; NIA)

    • Dissemination and Implementation Research

      • R01; R21; R03 (multiple institutes)


Pcori and other funding sources
VA

  • Not much specific to CER and PCOR


Resources
Resources

  • CER Program

    • http://accelerate.ucsf.edu/research/cer

    • Consultation resources

      • 5 free hours of consultation thru consultation services

      • Links to high value consultation opportunities

        • Community Engagement & Health Policy

        • CELDAC

        • SF Bay Area Collaborative Research Network

    • Symposium

    • Updates and Announcements – listserv

    • Collaboration around RFAs


Questions comments
Questions / Comments ?

Mike Steinman

Mike.steinman@ucsf.edu

http://accelerate.ucsf.edu/research/cer