pcori hickam ucsf 1 16 2014 ver 2

PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE

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UCSF SymposiumSan Francisco, CAJanuary 16, 2014

David H. Hickam, MD MPHDirector, Clinical Effectiveness ProgramPatient-Centered Outcomes Research Institute (PCORI)

PCORI’s Approach to Providing Support for Comparative Effectiveness Research

How to Improve your Likelihood of Success

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Key Questions for this PresentationKey Questions for this Presentation

• What is patient centered outcomes research (PCOR)?

• How is PCORI promoting best practices in research?

– System for review of applications

– Methodology standards

• What types of projects have the best chance of receiving funding from PCORI?

• What are the pitfalls to avoid?

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Preaching to the Choir?

PCORI Awards to UCSF Investigators

David Thom Health Team Support for Patient Informed Decision Making

Stephen Hauser A BioScreen for Multiple Sclerosis

Carol Mathews Comparison of Peer-Facilitated Support Group and Cognitive Behavioral Therapy for Hoarding Disorder

Christine Dehlendorf Patient-Centered Support for Contraceptive Decision Making

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Preaching to the Choir?

PCORI Awards to UCSF Investigators (cont.)

Tung Nguyen A Patient-Centered Intervention to Increase Screening of Hepatitis B and C Among Asian-Americans

Mary Whooley Improving Delivery of Patient-Centered Cardiac Rehabilitation

Anna-Barbara Moscicki Randomized Trial to Increase Adherence to Cervical Cancer Screening Guidelines for Young Women

Rebecca Smith-Bindman UCSF CT Radiation Dose Registry to Ensure a Patient-Centered Approach for Imaging

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Preaching to the Choir?

PCORI Awards to UCSF Investigators (cont.)

Rebecca Sudore Preparing Spanish-speaking Older Adults for Advance Care Planning and Medical Decision Making

David Thom Health Coaching to Reduce Disparities for Patients with Chronic Obstructive Pulmonary Disease

Charles McCulloch Methods for Analysis and Interpretation of Data Subject to Informative Visit Times

Mark Pletcher The Health eHeart Alliance

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PCORI Aims to Improve Healthcare Decision Making Making

• An independent, non-profit organization authorized by Congress.

• Mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.

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What is Patient Centered Outcomes Research?

Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make informed health care decisions.

PCOR is a type of comparative effectiveness research.

PCOR has the following characteristics:

•Actively engages patients and key stakeholders throughout the research process.

•Compares important clinical management options.

•Evaluates the outcomes that are most important to patients.

•Addresses implementation of the research findings in clinical care environments.

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PCORI Funding – ApproximatePCORI Funding – Approximate

2012

2013

2014

2015. . . .

2019

$150,000,000*

$300,000,000

$500,000,000

$500,000,000

$500,000,000

* 20% of this amount goes to AHRQ/HHS each year for dissemination and capacity-building

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Advise Us on What PCORIShould Study:

Advise Us on What PCORIShould Study:

Tell Us How We Are DoingTell Us How We Are Doing

Review Proposals andPartner in Research

Review Proposals andPartner in Research

Help Us Share the Findings

Help Us Share the Findings

Patientsand

Stakeholders

Patientsand

Stakeholders

Topic generationResearch prioritization

Merit ReviewParticipate in research

How can we improve on what we are doing?

DisseminationImplementation

PCORI’s Rationale for Engagement

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Our National Priorities for Research

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Characteristics of Projects that will ReceiveCharacteristics of Projects that will Receive PCORI FundingPCORI Funding

• The studies address critical decisions that face patients, their caregivers, and clinicians.

• The decisions must be consequential and be occurring without key evidence about the comparative effectiveness of two or more options.

• The studies address comparative benefits and harms of the options and provide information about outcomes that are important to patients.

• The new knowledge can be used by patients, caregivers, and their clinicians for making decisions.

• The studies Include relevant patients and other stakeholders on the research team.

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Two Pathways to PCORI Funding

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Diverse portfolio addressing high-priority questions

Diverse portfolio addressing high-priority questions

Investigator-Initiated or “Broad” Pathway”

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Patient/Stakeholder-Initiated Pathway – “TARGETED”

Focused portfolio addressing high-priority questions

Focused portfolio addressing high-priority questions

Two Pathways to PCORI Funding

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Programs launched in 2013:

•Treatment options for uterine fibroids in women of childbearing age.

•Prevention of falls in residents of assisted living facilities.

•Improving the care of asthma in Latino and African American populations.

PCORI Targeted Funding Programs

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Some Projects are Outside of PCORI’sSome Projects are Outside of PCORI’s PrioritiesPriorities

•Cost-effectiveness analyses or studies that primarily address costs of care as an outcome.

•Studies that develop new methods of measurement.

•Studies of the efficacy of unproven treatments.

•Natural history studies.

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Patients are Engaged in Reviewing Research Patients are Engaged in Reviewing Research ApplicationsApplications

• PCORI uses multi-stakeholder review panels to review the applications submitted by investigators.

– 50% of the members of review panels are either patients or other key stakeholders.

• The panels evaluate and score the applications and stakeholder engagement.

• Patients and other relevant stakeholders must be included as members of research teams and involved in all aspects of the project.

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Criteria Used by PCORI Merit Review Panels

• Impact of the condition on the health of individuals and populations

• Potential for the study to improve health care and outcomes

• Technical merit• Patient-centeredness• Patient and stakeholder engagement

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Which Strategies are Likely to be Successful when Seeking Funding in 2014?

• PCOR should compare clear clinical options.

• Be cautious with a “usual care” comparator.

• The clinical interventions should be easy to replicate: path to dissemination.

• Do not neglect engagement.

• Make sure that the outcomes are meaningful.

• Address both benefits and harms.

• Cover all of the Methodology Standards.

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Program on Assessment of Prevention, Diagnosis, and Treatment Options

Developing a portfolio of comparative effectiveness research that assesses important clinical management options.

•Broad range of clinical populations.

•Studies of specific clinical interventions.

• Procedures, medications.

• Care strategies and tools.

•Have funded 67 projects in first four cycles.

•Portfolio includes both clinical trials and observational studies.

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Targeted Funding Initiatives in the Assessment of Options Program

New clinical areas being developed for targeted initiatives

– Management strategies for ductal carcinoma in situ

– Treatment of bipolar disorder in adolescents and adults

– Treatments for osteoarthritis

– Treatments for migraine headaches

– Announcements due in 2014

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Addressing Disparities Program

Program’s Mission StatementTo reduce disparities in healthcare outcomes and advance equity in

health and health care

Program’s Guiding PrinciplePCORI is not interested in studies that describe disparities; instead,

we want studies that will identify best options for eliminating disparities.

PCORI’s Vision, Mission, Strategic Plan

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Improving Healthcare Systems Program

PCORI’s IHS program will incorporate the perspectives of patients, stakeholders and scientists to produce new

scientific evidence that will:

•Improve the quality and efficiency of critical components of the US healthcare system

•Improve the health-related outcomes that matter most to patients and their caregivers

•Inspire others to emulate PCORI’s success.

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Focus of Research in the IHS Program

Innovations in:

Use of health information technology

Deployment of human resources

Incentives to drive system improvement

Special clinical programs

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Accelerating PCOR and Methodologic Research

• Methods– Broad announcement, every 4 months, ~ $12 mil– Up to $250,000 direct costs per year, up to 3 years– Analytic methods, outcomes measurement, engagement

methods– Increasingly will align with Methodology Committee

priorities

• Data Infrastructure Announcements– Clinical Data Networks– Patient-Powered Networks– Coordinating Center

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PCORI Requires Adherence to its PCORI Requires Adherence to its

Methodology StandardsMethodology Standards

• Formulating Research Questions

• Patient-Centeredness

• Data Integrity and Rigorous Analyses

• Preventing/Handling Missing Data

• Heterogeneity of Treatment Effects

• Data Networks

• Data Registries

• Adaptive and Bayesian Trial Designs

• Causal Inference

• Studies of Diagnostic Tests

• Systematic Reviews

47 Individual Methodology Standards

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Characteristics of the Methodology StandardsCharacteristics of the Methodology Standards

• Are minimal standards for performing comparative effectiveness research.

• Are intended to provide helpful guidance to researchers and those who use research results.

• Reflect generally accepted best practices.

• Provide guidance for both project protocols and reporting of results.

• Are used to assess the scientific rigor of funding applications.

• Context of research should drive use of the standards.

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The Methodology Standards are Reasonable

• Engage people representing the population of interest and other relevant stakeholders in ways that are appropriate and necessary in a given research context.

• Use Patient-Reported Outcomes When Patients or People at Risk of a Condition Are the Best Source of Information.

• Document Validated Scales and Tests.

• Specify Plans for Data Analysis that Correspond to Major Aims.

• Use Validated Methods to Deal with Missing Data that Properly Account for Statistical Uncertainty Due to Missingness.

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The Methodology Standards are Reasonable but also Rigorous

Report the assumptions underlying the construction of propensity scores and the comparability of the resulting groups in terms of the balance of covariates and overlap.

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Conclusions

• Patient-centered outcomes research (PCOR) provides relevant information to help patients and providers choose among alternative clinical strategies.

• Applicants for funding should engage patients and stakeholders in identifying questions and defining important outcomes.

• Projects should directly address important clinical comparisons and examine meaningful outcomes.

• The PCORI Methodology Standards guide best practices for planning, conducting and reporting research.

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Join Us at PCORI.orgJoin Us at PCORI.org