The Patient-Centered Outcomes Research Institute (PCORI)-the comparative effectiveness research body formed by the Patient Protection and Affordable Care Act of 2010 (PPACA)-published its draft research agenda on 23 January, 2012.
The institute was the result of a little-noticed provision in the sprawling healthcare overhaul bill, but has been shaping up to be highly influential in health policy circles. While PCORI's economic clout is initially limited-it recently granted just $26 million dollars to 40 projects-the institute's projects aim to radically overhaul how patients and providers interact with the healthcare system.
The Draft National Priorities for Research and Research Agenda outlines what PCORI hopes to do in the coming years. The report notes that PCORI will be focusing on comparative clinical effectiveness research with an emphasis on generating research that patients can use.
The report prioritizes five research areas that it hopes will serve as a broad base for research initiatives:
- Comparative assessments of prevention, diagnosis and treatment options to determine the best treatment options for distinct subpopulations
- Ways to improve the healthcare system, especially through coordination of care for patients with multiple chronic conditions
- Ways to communicate healthcare information to patient to inform better healthcare decision making with clinicians
- Addressing healthcare disparities, including treatment effectiveness disparities
- Designing methodological research to be quicker, safer and more efficient
The categories chosen by PCORI are intentionally broad. "This draft Research Agenda does not specify a restricted set of conditions or treatments that PCORI will study […] PCORI's priorities and agenda do not place such limits on the scope of research that will be supported," notes the report. PCORI hopes that a "diverse research portfolio" along with partnerships and dialogue with public and private entities will provide a wide platform for comparative effectiveness research to build on.
"Health equity is going to be one of the priority areas within [PCORI's] research agenda," said PCORI COO Anne Beal in an interview with Kaiser Health News last month. The agency-and its funding-will "help people decide what's best for them in getting their desired health outcome," which will further this agenda, according to Beal.
PCORI does have some limitations that have been set upon it as a result of the 2010 political battles over the PPACA. For one, the government cannot direct PCORI's research agenda-the result of fears over government-sponsored "death panels". The US Department of Health and Human Services, too, is limited in how it can use the research in making coverage decisions as a result of those same fears.
The institute hasn't been immune from criticism after being formed either. While PCORI Director Joe Selby has been making the case that PCORI's job is only "to make the evidence available," Kathryn Nix of the conservative Heritage Foundation is more concerned about the long term.
"The more concerning thing is not the institute itself, but how the findings will be used in other areas. Will [PCORI's research] be used to make coverage determinations?"
That argument may already be starting to play out in the private sector. Insurers plan to aggressively use PCORI's data to drive best practices and reduce ineffective treatments. While this isn't new-insurers have been conducting comparative effectiveness research for decades-it does carry with it the credibility of a government agency.
PCORI's board of governors has attracted some of the premiere names in the health policy world, and has already received "an extremely high volume" of applications for its Pilot Projects Grants program.
PCORI's ability to translate their research goals in to actionable projects may make the small agency in to a big player in the health policy world.
Comments on the draft agenda are due by 15 March 2012.